Co-op leaders must speak out to protect members’ health care

Reckless and hasty “repeal and delay” of the Affordable Care Act by Congress will inflict a disaster on co-op members, our communities, and the economy. The process must be slowed down and more thoughtfully pursued, which the leaders of America’s 130 million cooperative member-owners can achieve. We have the power to do it, and we must use it on behalf of our members to avert a disaster.

The Affordable Care Act (ACA) has been imperfect, controversial, and a favorite punching bag of politicians since its inception in 2010. But the fact remains that 20 million Americans[1] — millions of them member-owners of rural electric cooperatives, credit unions, and food co-ops — rely upon the ACA for access to medical care. Every hospital in America relies on it to subsidize care for Medicaid recipients. And every community in America relies on its hospital for medical treatment for all, regardless of their health insurance provider, and for being a large and stable employer. Knocking over the first domino and disrupting 16% of America’s economy without a plan to re-stabilize it or a thought for the consequences is a reckless recipe for layoffs, recession, and severe damage to our communities.

Make no mistake, this is exactly the course we are on with the current “repeal and delay” plan, which could be up for a vote in the Senate as early as Thursday this week. The Affordable Care Act was created to be a delicate balance of incentives and compromises to make markets work[2]. Insurance companies have to do X, but we’ll offer Y. People have to carry insurance, but the federal government will offer subsidies to make it affordable. Congressional Republicans put forward a plan to defund the subsidies immediately[3] — take away the Y — while still expecting X. This is like taking one person off a teeter-totter and expecting it not to come crashing down.

The trade association of the health insurance companies[4] is worried that “repeal and delay” will plunge the health insurance market into uncertainty and instability[5], and that even Americans who don’t have coverage through the ACA exchanges — all told, 30 million of us — may lose our health insurance coverage much faster than the two, three, or four year sunset that the GOP might be hoping for. This is exactly what the American College of Physicians warns in a letter to Congress[6], as well as a former health insurance company CEO, J.B. Silvers, in a recent essay[7]: that market uncertainty in the short term will force insurance companies as early as next year to drop insurance in high-risk counties[8] most likely to be served by rural electric cooperatives. The two major associations of hospitals have written a joint letter to President-Elect Trump and Congress[9] warning that the plan to defund the subsidies through the budget reconciliation process, rather than an actual ACA replacement bill — a hack to democracy itself — would so severely defund America’s hospitals that many would be forced to close. They remind Trump and Congress that hospitals are one of the largest employers in many small communities and that closing them would cause mass layoffs and secondary economic effects as formerly employed doctors and nurses leave town for a hospital somewhere else. The American Academy of Actuaries writes in a letter to Congress[10] (in as strong and chilling words as actuaries use!) that,

“significant market disruption could result, leading to millions of Americans losing their health insurance… the American Academy of Actuaries’ Health Practice Council strongly encourages you to recognize the potential unintended consequences inherent in leaving the individual market without the certainty it requires to remain sustainable by neglecting to also enact a viable replacement.”

The issue should not be how bad the damage caused by this chaos could be. The issue must be stopping such reckless action and bad policy from ever making it through the once proud establishment of our American Congress. If something so threatening to the survival of our cooperative businesses — let alone one-sixth of the economy — were ever attempted on such a rushed timescale purely for political reasons[11] by one of our employees, we’d fire them in an instant. We all know this.

While several Republican Senators, including Lamar Alexander (R-TN), Bob Corker (R-TN), and Susan Collins (R-ME) have expressed their concern[12], in the absence of serious constituent backlash, the pressure on them will be to vote with their Party, and America will go over this cliff 52–48. After all, every Republican politician has, for the past six years, campaigned on a platform of undoing Obamacare and going back to the way things were, when 50 million Americans lacked health insurance[13] and medical bankruptcies were shockingly common. But Donald Trump ran AGAINST this heartlessness in the Republican Primary[14], using it as a major point of contrast to differentiate himself from the Republican Establishment. The President-Elect said that, unlike his opponents, he would never let people “die on the street.”[15] He routinely said[16] his goal would be that all Americans would have insurance coverage, especially America’s poor and vulnerable[17], and that he would not repeal Obamacare without a replacement that resulted in universal coverage.

And his rural supporters heard him loud and clear[18]. Many of them are electric co-op member-owners and our constituents, exactly the target audience for NRECA and NCBA’s “Co-ops Vote”[19] initiative to get rural cooperative members to turn out in record numbers. They are the people who are most likely to get their health insurance through the Affordable Care Act’s exchanges and most overwhelmingly supported Donald Trump for president[20], and they are quite certain they did not vote to lose their health insurance. For example, take Kathy Oller, a woman living in Whitley County in southern Kentucky and very possibly a member-owner of the Cumberland Valley Electric Cooperative. She was interviewed last month[21] by the journalist Sarah Kliff. The interview is beautiful and heartbreaking. She voted for Donald Trump and makes her living selling Affordable Care Act policies in coal country, to so many people she’s lost count. She doesn’t think it’s possible that such an important program could be taken away, one that provides health insurance to 20 million Americans like her and her customers who wouldn’t be able to get insurance without it. She heard Trump say he was going to repeal it, sure, but she heard Trump say a lot of things and rightfully took them with a grain of salt. What she heard loudest was that he was going to Washington to work for people like her and her community. To make their lives great again.

This is the promise we must hold him to. Once Trump is in office, with an ascendant one-party Republican government, he will come under immense pressure by Speaker Ryan and other members of the same Republican Establishment to fall in line with the Republican Party’s goal of eliminating Obamacare, with or without a replacement and come what may. This is unacceptable. For our cooperative member-owners’ sake, we cannot let that happen. Americans may be divided on many issues right now, but not on keeping the Affordable Care Act. Only 25% of Americans believe it should be repealed[22]. The other 75% want it improved or strengthened.

This is an urgent moment, perhaps more urgent than even leading up to the election. Many of our member-owners are still feeling the same pain of an economy that has left them behind. They voted for new politicians to alleviate that pain, and it’s the incoming President and Congress that now hold the job. It’s now urgent for the NRECA/NCBA “Co-ops Vote” initiative to switch gears, joining with co-op leaders to remobilize constituents to hold elected officials accountable to the promises they made on the campaign trail, as well as to improving the lives of our people and their communities — whatever they promised. As we all know, the second that new politicians take power, they are immediately buffeted by powerful interests seeking to bend them. The swamp fights back, as it were, and one need only look at the recent attempt by the House GOP to defang the Office of Congressional Ethics on Day One[23] as proof. Representatives backed down after finding “their offices inundated with angry missives from constituents amid a national uproar.” Only the continued strength and organized power of mobilized voters — our cooperative member-owners — can serve as a counterweight to powerful special interests, reminding our officials who put them in office and what we expect.

The potential ACA repeal directly affects our cooperative member-owners. A letter from a group of 13 Senators[24] — including those from the co-op heavy states of Minnesota, Colorado, Indiana, New Hampshire, North Dakota, Missouri, Michigan, and others — to the Republican Senate leadership highlights how much more difficult it will be to deal with the opioid epidemic ravaging many of America’s rural communities with the loss of options and protections from the Affordable Care Act, to say nothing of local community hospitals being forced to close.

Cooperative leaders have a responsibility to speak out. If we want to claim to speak for cooperative member-owners, or mobilize the 130 million American cooperative member-owners “to really impact the lives of individuals, families, and communities” as a “force for good”, as NCBA’s CEO, Judy Ziewacz, said at October’s Co-op Month panel discussion[25], cooperative leaders must show that we care about the most urgent issue affecting our members, their families, and their communities right now, today. The state and national electric co-op associations have been powerful and effective advocates against the Clean Power Plan on the basis that it would allegedly raise a typical member-owner’s electricity bill as much as $18 per month[26]. Where is this strength and leadership when those same members’ health insurance bills may go up hundreds of dollars per month? Or they may lose access to health care altogether, because insurance companies pull out of their county, or because they’re one of the 52 million non-elderly Americans with a pre-existing condition[27] that would allow insurers to deny them coverage without the Affordable Care Act’s protections?

Grant Williams, a grad student at MIT and electric co-op researcher, crunched the numbers on how many electric co-op members would be affected by the repeal of the ACA. Look at these numbers and think seriously about just how brutal a sudden repeal will be. Out of 42 million rural electric co-op members, there are about 2 million who get their insurance from a federal exchange and many more who get it from the state ACA exchanges. They all stand to lose their health insurance, along with tens of millions of others, under “repeal and delay”.

Our member-owners have urgent needs: access to health care, communities with open hospitals, and a stable economy to help them get back on their feet. Unlike investor-owned corporations, our co-ops don’t exist to maximize shareholder profits. They exist to serve the needs of our members. If you are the CEO of an electric cooperative in Tennessee, you make hundreds of thousands of dollars of member-owners’ money per year for serving your members’ needs, but thousands of your member-owners are about to lose their health insurance. Both of your Republican Senators have publicly expressed their concerns with the Republican Party’s plan of repeal without a replacement. When was the last time you called them to advocate for your cooperative and your member-owners’ interests? Was the issue facing your members more grave than this one?

I served on the NCBA 2012 conference planning committee and remember well the words that Wilson Beebe used as NCBA president to open the member meeting in Seattle that year. “Health care reform in the United States came and went,” he said, “and co-ops were not ready.” Are co-ops any more ready today for repeal of that reform? The letter by NCBA CLUSA to the Trump transition team about cooperative interests[28] is totally mute on health care.

Are we willing to advocate on this issue to protect our member-owners, their interests, their families, and our communities? It’s up to us to take the first step, and the clock is ticking. Call your association head to take action. Let your member-owners know where you stand, and encourage them to take action, too. It’s the right thing to do for your member-owners and for your community. And together, let’s prevent ever having an NCBA meeting where we say, “Health care repeal came and went, and co-ops were not ready.”

Jake Schlachter is the founder and executive director of We Own It, a start-up nonprofit building the national network for cooperative member-owner rights, education, and organizing.