CONSTANT VIGILANCE — but also, go ahead, take a nap.

Donald Trump promised to repeal the Affordable Care Act on day one of his administration. With the support of a Republican Congress, he had every advantage needed to make that a reality. And every day since has been a victory.

So first of all, thank you. Thank you to anyone who called their Senators, anyone who tweeted and posted on Facebook, anyone who went to their Senators offices, or attended a protest. Thank you in particular to the many, many ADAPT activists who were arrested and to Andy Slavitt who kept us all informed (and is making me REALLY ANXIOUS with his twitter hiatus right now) and to Ben Wikler of Move On whose organizing skills were top notch. Thanks to the Kaiser Family Foundation for their reporting and their scoring, and the hundreds of other groups who mobilized their members in defense of healthcare.

Thank you to the Senate Democrats who never wavered, even those representing states that went for Trump by large margins. Thank you for giving us the space to pressure others, to reach out to friends in other states, to phone bank, without having to worry that you might fold. Thank you to Senator Susan Collins who stood fast in defense of her constituents the entire time despite the bullying and the pressure, and to Senator Lisa Murkowski who listened and learned and voted accordingly.

And yes, thank you to John McCain. You kept a lot of people up that night, and the nights before, but credit where credit is due — you stuck by your word.

If you want to have some feels about this from people who are better writers than I am, check out this and this. I shivered.

Everyone, breathe a sigh of relief and pat yourself on back.

Okay, you done yet?

Unfortunately, as was pointed out by many in the days after the initial defeat of the repeal, the Affordable Care Act will not be safe until Democrats take back Congress. But that’s 2018’s problem. Right now, there are a couple of things coming up that we at the Nevertheless Project will be paying attention to and we hope you will be too. Or at least, pay attention to us paying attention to it. We won a pretty decisive battle, but ensuring that every American has access to affordable, comprehensive healthcare is an uphill climb and there are still a few battles on the horizon before we get to the big one. Here’s where we are now:

First, the Good News: When Anthem announced that it was pulling out of the individual market, gaps in coverage started popping up everywhere. But because insurance regulators and companies stepped up, and because of subsidies that make it financially feasible, there are only about 19 counties across the country that will have no insurance plans on the individual market in 2018, which means only about 15,000 enrollees. This is much better than the original 49 counties projected earlier in the year.

In Minnesota, premiums may actually decrease if the White House approves a plan to create a reinsurance fund, which essentially pays insurance companies to offset the cost of the sickest enrollees. A similar plan was approved in Alaska, and it allows insurance companies to set lower premiums because they know they will be getting some of that cost covered.

Cassidy-Graham-Heller Bill: Believe it or not, there is another Affordable Care Act repeal act floating around out there. It first popped up as an amendment to the Better Care Reconciliation Act, but its sponsors, Lindsey Graham (R-SC) and Bill Cassidy (R-LA) are now shopping it around as its own bill. Essentially, it cancels the current federal funding for Medicaid expansion, premium tax credits, and cost sharing reductions and creates a $140 billon fund that would be distributed to states as block grants to do with what they will. Problems include the fact that states would not have an obligation to use this money to help their low-income residents afford health insurance. Additionally, the $140 billion fund would be $26 billion short of where funding currently is, without taking into account that the current Medicaid expansion is spread over 30 states and this fund would be spread over all 50.

There doesn’t seem to be a whole lot of zeal behind this plan. The White House supports it, but their skill in pushing through a legislative agenda is sorely lacking, and enthusiasm in the Senate is low. Senator Lemar Alexander (R-TN) announced that the Senate health committee will hold hearings on the individual insurance market in September, so the likelihood of the Senate finding the votes and rushing something through in the next few weeks is slim. Experts, of course, believe that this will also kick millions off their insurance. No surprise there, since it is built on the foundation of the BCRA.

And yes, Senator Dean Heller of Nevada, notorious coward and infamous flake, has signed onto this bill. Because once you’ve sold your soul to Steve Wynn, you might as well go all in.

Cost Sharing Reductions: When Donald Trump tweets that he is going to let Obamacare fail, this is what he’s referring to. Essentially, this is a “$8 billion health law fund that pays for low-income Obamacare enrollees’ copayments and deductibles” (Vox). The Trump Administration has been making these payments monthly, but each month they also threaten not to make the payments, striking fear and uncertainty into the hearts of insurers and insured everywhere. Consequences of refusing to pay these CSRs include skyrocketing premiums, and hospitals and healthcare providers on the hook for lots of unpaid bills.

For example: Blue Cross Blue Shield in Arizona plans to raise premiums 7.2% in 2018, but has stated that premiums would be even to 2017 if the cost sharing reductions continued.

Even GOP Senators want to ensure that these payments continue going forward. The August payments are still up in the air, but by the time the September deadline rolls around Congress will be in a position to ensure those payments themselves. Heads or tails whether any of the GOP still has the spine to do this in September, but it’s an option.

There is also a theory floating around that if Trump refuses to pay the cost sharing reductions, insurance companies can offset the cost to consumer by just raising the premiums on individual market’s Silver plans. Those are the plans that the subsidies are based on, so as long as the subsidies are in tact, they will rise commensurate with the rise in premiums and the federal government will bear the brunt of the costs. But it’s just a theory, and not worth hanging our insurance markets on. Source (why yes, my source is just Andy Slavitt’s entire Twitter account).

These CSR payments are also subject of a current lawsuit. Under the Obama Administration the White House began making these payments to stabilize the insurance markets in large part because Congress wouldn’t act to do so. The lawsuit claims that this goes beyond the purview of the Executive branch. Until recently, there was no one to defend the payments as the Trump Administration also doesn’t want to shell out the funds, but a recent court decision allows Democratic attorneys general to defend them. If Congress takes action, however, we might be able to circumvent that issue entirely.

………………………….

If, like me, you reached the end of this hodge podge mess of a summary and thought to yourself, “Wait, what did we win?” don’t worry — you aren’t alone. The healthcare fight is steeped in the very worst of partisan politics. Obstructionist policies, compromises, exclusionary tactics and vitriolic in-fighting have made this a mud fight from the beginning. And for so many of us who worry about money and illness, whose friends and family face impossible challenges every day, this is not a matter of win/loss columns, attack ads, and pressure from casino magnates. Our bodies are at stake, our families, our lives. And it can make the best of us cynical. It can engender the belief that we are alone, that even the best of us can be brought down by selfishness or greed.

So instead, remember this — thousands of people across the country showed up. Some were parents. Some were Trump voters. Some were politicians. Some were in wheel chairs. Some were dying. And some of them just knew a wrong when they saw one. None of us are going to get it right all the time. Some battles will be lost. Some victories will be pyrrhic. We will, again, be disappointed. But as long as we keep showing up, as long as we can find the good in ourselves and recognize the good in others, we can keep fighting. And sometimes, we’ll win.

Maybe it wasn’t a very good campaign slogan, but it’s true nonetheless. We’re stronger together.