January 22, 2021

Long strange trip

 I've been wracking my brain trying to think of what to say about the events of the week and the years that went before it. For most of the fall, I've been very concerned about the possibility of a coup, quasi-legal or otherwise. I'm still wondering what kinds of violent stunts white nationalist groups may unroll and what other long term damage has been done to the democratic process, imperfect as it is. 

I'm hoping that the nation's flirtation with fascism or at least authoritarianism is at least waning.

Aside from issues of authoritarianism, the last four years have involved a lot of defensive fights, mostly revolving around health care (food security too, but that's another story). If there's been a central theme of my nearly 32 years at AFSC, health care would be it.

My first big fight was the Pittston strike, which was mostly about retiree health and pension benefits. These were also factors in the 1990 teachers' strike and the 1990-92 Ravenswood lockout. Ditto the fights about "reforming" workers compensation that lasted for a decade between the mid 1990s and 2000s. 

The coming of welfare "reform" in 1996 started another decade or so of sporadic fights related to Medicaid. These included issues like transitional coverage for people leaving cash assistance, the possibility of block grants, waivers and such. 

Then came efforts to get the state to implement the federal Children's Health Insurance Program in 1998 and then to expand eligibility for it, eventually up to 300 percent of the federal poverty level by 2011. My late co-worker Carol Sharlip was a major player in building support for this in the early years.

In 2009-2010 came the push to enact what eventually became the Affordable Care Act. I remember going to public hearings around the state and witnessing the WV version of the birth of the white backlash and the Tea Party. These included paranoid ravings about the World Health Organization taking over and someone heckling a priest during an opening prayer. And, yes, people who wanted to keep the government's tentacles off Medicare. There were street actions, press conversations, calls, emails, op-eds, bus trips to DC, and all that. Then lots of outreach and education when it passed.

(There were some serious debates within AFSC about whether to sign on in support of the bill. Some didn't think it was good enough. I may or may not have stopped talking with some people after that.)

The version we got was the Senate's rather than the more generous House version in March 2010. Here's a blog post I wrote about it at the time. Then the 2012 US Supreme Court decision which let it stand but made Medicaid expansion--the real public option--a state decision. The biggest social justice victory of my lifetime was then-Governor Tomblin's decision to expand it. Here's a report we published in an effort to nudge the governor in 2013. My retired colleague Beth Spence did the interviews and photography.

I would never have guessed the state would do such a great job at enrolling people. At it's peak around the time of the 2016 election, the expansion covered nearly 180,000 West Virginians (after four years of assaults by the Trump administration, I think enrollment is around 160,000 now). The new president, aided by WV's attorney general, promised to do away with the whole ACA as soon as he came into office.

It was an all-hands-on-deck moment. Health advocates scrambled to the defense. My co-worker Lida Shepherd and I worked with Cabin Creek Health Systems to interview people covered by the ACA and publish the results and generate other media, including a widely seen video report in the New York Times. Given that WV has been ground zero for the opioid epidemic, protecting the ACA, which opened up recovery to thousands, was critical.

We worked with allies to do all the usual stuff. Some friends of ours, nicknamed "the Capito six," were arrested for sitting in at the WV Republican senator's Charleston office. I remember protesting outside WV's giant Boy Scout center when the President spoke. People put lots of effort into bolstering Senator Manchin's support for the ACA. He eventually came around to a "fix, don't nix" position. In a closely divided Senate, WV was in a critical spot, with a conservative Democrat and fairly moderate Republican. People hit it with all they had.

The critical moment came in July 2017 when a dying John McCain cast a deciding vote after returning from hospital treatment for brain cancer, basically saving the day. Here's a post on that occasion that includes his eloquent statement.

After a pause to catch our breath, WV health care advocates turned next to fight off bad state legislation regarding work reporting requirements for Medicaid expansion that would have kicked tens of thousands of low income West Virginians off the program in 2019 and 2020. I'm hoping that COVID-19 has shown this to be a Really Bad Idea.

By the time of the 2020 election, the ACA was battered but still afloat, although it wasn't clear if it could survive another four years of federal assaults. Then there was the added wrinkle of the US Supreme Court taking up another repeal attempt with three Trump appointees. The decision is expected as soon as this spring, but early deliberations seem promising.

So I guess this is another catch the breath moment. We're still far from universal care, but it's been a long hard fight to get as far as we have. I'm grateful to the many friends who have been in the fight from the beginning. Like the ACA, we're battered but still around.

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