Published on Politico Pro, 02/23/2017 02:19 PM EDT
By Rachana Pradhan
The fiery confrontations over Obamacare sweeping town hall meetings from California to Virginia are giving progressive groups hope they can build the sustained movement that helped push the health law to passage in 2010.
But while Republicans charge the dust-ups are stoked by moneyed interests, foundations and health care interests crucial to the ACA cause are largely on the sidelines — and no health policy-obsessed billionaire has emerged as a white knight. Without cash, the smaller organizations left could be hard-pressed to fight a long battle as conservatives spend heavily to pressure lawmakers to finish off the law and, possibly, revamp Medicaid.
“If you’re looking for where funding used to go to fight for the health care bill … I think you gotta keep looking,” said Ezra Levin, a former Democratic congressional staffer now helping direct the Indivisible Project, which is organizing pro-Obamacare demonstrations and other protests against President Donald Trump’s agenda. “It’s not coming to us, at least not right now.”
The money has been missing for several years. After securing ex-President Barack Obama’s signature domestic policy achievement, key players involved with messaging and advocacy declared victory and moved on without fully completing the sales job. The Health Care for America Now coalition, one of the most audible voices in getting the law enacted, folded in late 2013 after mounting a $60 million campaign to pass Obamacare and protect it during implementation.
It’s left to groups such as the Indivisible Project to confront GOP lawmakers and tap outrage or voter anxiety over the GOP repeal-replace effort. The progressive forces also include the Protect Our Care campaign backed by labor unions and health consumer groups, and some of the original backers of Health Care for America Now. Another group, the Alliance for Healthcare Security, has aired several rounds of ads that are largely being funded by the Service Employees International Union, though the SEIU declined to specify how much it had contributed.
Huge amounts of cash for advertising and outreach may not be as essential in a social media-fueled crucible, where town hall confrontations can almost instantly go viral and organizers can rely on Facebook and other tools to mobilize. The pro-ACA groups scoff at the notion advanced by the Trump administration and some GOP lawmakers that Democrats are paying protesters to make a ruckus over Obamacare at town halls. “To say that we’re a ‘grasstops’ thing is a complete lie,” said Indivisible Project co-founder Angel Padilla.
But the pro-ACA groups still face a daunting task. Republicans intent on not only dismantling the ACA but capping the open-ended nature of Medicaid are getting backing from money powerhouses such as the American Action Network, which is aligned with House Republicans, and One Nation, a group with ties to Senate GOP leadership that’s spending millions of dollars targeting vulnerable Democratic senators up for re-election in 2018.
Progressive activists similarly capitalized on generous support from pharmaceutical manufacturers and nonprofits such as Atlantic Philanthropies and the Robert Wood Johnson Foundation during the heated debate to pass Obamacare. Nearly eight years later, the high-rollers have moved on, leaving health law defenders to make do with paltry budgets.
Levin said most of the 7,000 donations the Indivisible Project has received come from “small dollar” donors who pony up about $50. Padilla said the sum is “just enough to keep us going.”
“We have gotten enough to keep us going another three or four months,” said Padilla, who also works on health issues for the National Immigration Law Center.
“There’s never enough money in the health care advocacy community,” said Ethan Rome, who led Health Care for America Now during the run up to pass Obamacare and is trying to revive it. “That’s never stopped us.”
The activists for now are relying on grassroots passion. Obamacare supporters argue that Republican plans to dismantle Obamacare will cut the safety net for 20 million people who obtained coverage for the first time through the law’s insurance exchanges or its expansion of Medicaid. Even more could be affected if the GOP makes good on plans to revamp Medicaid and end the open-ended funding mechanism of a program covering roughly one in five Americans.
“We didn’t have any illusions to think that this would be just about the ACA,” said Robert Restuccia of Community Catalyst, part of the Protect Our Care campaign. “It will be an expanded fight.”
Community Catalyst has received “hundreds of thousands [of dollars] in new funding” from foundations and individual donors, according to a spokesperson. Health Care for America Now organizers are also relaunching efforts with state partners to try to thwart Republicans — an effort that Rome says will comprise field operations around the country and be “lightly funded.”
In contrast, Health Care for America Now spent $48 million between July 2008 and March 2010 to get Obamacare passed, 40 percent of which went for advertising. The coalition managed to secure additional cash to continue defending Obamacare during the early years of implementation. But it was soon outgunned by conservative groups tapping anger over the law from the political right and closed its doors in late 2013. About half of the $60 million campaign it mounted at the end was bankrolled by Atlantic Philanthropies, a foundation that will shut down entirely by 2020.
Richard Kirsch, one of the individuals involved in relaunching Health Care for America Now, maintains that far less needs to be spent on ads today, where voter angst over repeal has become standard fare on Facebook, Twitter and other social media channels.
“We don’t need the kind of budget we had last time because we’ve got this huge upsurge of what you can’t buy — that’s total genuine outrage,” Kirsch said.
“A lot of what we’re seeing in the country over the last several weeks has really been organic,” said Leslie Dach, a former Obama administration official who is leading Protect Our Care. “It’s come from people who realize that, ‘Oh my God, they might really take my health care away.’”
Health care advocates and other Obamacare defenders say they have received some additional funding from foundations, individuals and organized labor. They expect to see more, but still come up short against conservatives’ haul.
Through the Alliance for Healthcare Security, advocates have spent $3 million on ads in six states and the District of Columbia targeting moderate Republican senators over Obamacare repeal, with the funding largely coming from SEIU, according to several sources.
That’s less than the $5.2 million the American Action Network spent in January alone on ads to boost the repeal efforts. The group on Wednesday announced it would spend another $2.2 million on Obamacare-related ads. Separately, One Nation, a conservative group with ties to Senate Republican leadership, on Wednesday announced a $2.3 million ad buy that will target vulnerable Democratic senators up for re-election in 2018, as well as GOP moderates.
Funding from health industry groups also hasn’t materialized, unlike eight years ago, when powerful lobbying organizations with a stake in reshaping the health system poured massive sums into helping pass Obamacare. Drug companies devoted substantial resources to helping the Obama administration pass the law. Many such groups now are eager not to antagonize Republicans who control both houses of Congress and the White House.
“I expect more resources will be raised,” said Bob Greenstein, president of the Center on Budget and Policy Priorities, a left-leaning think tank. “I’m not sure they will be anything comparable to what’s on the other side.”
Liberals facing an uphill battle on funding is nothing new, Rome said. He argues, however, that GOP lawmakers will continue to experience huge blowback, because they’re trying to take something away from their constituents.
“These are programs that have powerful constituencies,” he said. “They can’t politicize an issue that is fundamentally personal to people.”