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Farewell to Health Care for America Now

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Health Care for America Now (HCAN), the grassroots campaign that powered passage of the Affordable Care Act, is about to close its doors, as planned when the campaign started. But the images it generated of Americans passionately fighting to make health care a right will remain with us for years to come. The new movie Inequality For All includes dramatic footage of an HCAN supporter standing up to a Tea Partier. Another documentary released last year, Escape Fire, has stirring footage of an HCAN rally. Pictures of people holding up HCAN signs or wearing HCAN buttons still appear regularly in news magazines. 

It makes great sense that HCAN's actions have become iconic symbols of the fight for health justice in the United States. From its beginning, the heart of the HCAN campaign was outside the Beltway, its strategy grounded in the firm conviction that we could only win the fight for comprehensive reform if we based our campaign on grassroots organizing outside of Washington. We knew that inside the Beltway, the best we could do is provide a credible voice countering the army of thousands of lobbyists for the health care industry. But outside the Beltway, by organizing ordinary Americans, we could win.

Creating a powerful grassroots force is not easy. It took building a campaign that pushed against the culture of D.C., with the support of a funder that was committed to building progressive capacity, not just winning on an issue. Most national issue campaigns are D.C.-centric, run by campaign operatives, constrained by a narrow band of legislative concerns, with an idea of field work that is narrowly focused on generating earned media and e-mails and phone calls to members of Congress. After a lot of debate, the union and community organizing leaders who built HCAN agreed to spend almost all of its non-paid media resources on field contracts with state-based community organizations and community labor coalitions. These local organizations partnered with the local chapters of national labor unions and netroots groups.

The national strategy and tactics were relentlessly focused on empowering people at the local level to bring their personal passion, and often their personal stories, to their communities and members of Congress. Their work did generate lots of local media and calls to Congress, but it went much deeper than that, building the kind of relationships that are transformational. The campaign's major funder, the Atlantic Philanthropies, was fully committed to the strategy, believing that even if the legislative effort fell short, their funds would leave in place a more sophisticated and robust capacity for progressive change at the local level. But because Atlantic had faith in the grassroots strategy, both of the foundation's objectives -- passing historic legislation and building capacity -- were realized.

While HCAN was always envisioned as a campaign that would end with the passage of legislation, HCAN's leadership decided to launch HCAN 2.0 to defend the new law after its passage. With many fewer resources, HCAN continued the fight, working on consumer regulations to control insurance premiums, taking part in the public battle around the Supreme Court's hearing on the ACA's constitutionality, defending Medicare from privatization, pushing for Medicaid expansion, and always reminding us that the opponents of the ACA are eager to return Americans to the day when insurance companies were fully able to deny them care and jack up their premiums because, indeed, we do get sick.

HCAN is now closing up shop. It may seem a funny time, with the current fracas over the implementation of the Affordable Care Act, but that is the point. The organization's campaign mission was to win passage of a law, a mission extended to include "win and secure" the ACA. The debate over the shape of the ACA will continue for years to come -- a struggle over how to fix, expand, roll back, or build upon the law. But as each of the millions of Americans who will enroll over the next few months sign up, another nail is hammered in the repeal coffin. Retiring HCAN, its mission accomplished, is another sign that the campaign is keeping its eyes on the prize.

HCAN affirmed my belief that people organizing together can shape history. Paul Starr, the Pulitzer Prize-winning historian of health policy, told me that none of the failed attempts to pass comprehensive health reform had a major, grassroots field component. Earlier this year another noted historian of health reform, Theda Skocpol, published an analysis in which she credited the success of health care reform versus the failure of climate change legislation to HCAN's deep grassroots strategy, compared with an elite, inside strategy of environmentalists.

It is good to see those lessons being fully embraced by new leadership in the climate change movement, as seen most sharply in the Keystone pipeline fight. The campaign for immigration reform too is powered by a national, grassroots movement led by local leaders who are putting their lives on the line for change. The most energetic new labor organizing is built on helping low-wage workers take local actions, supported by their communities, as part of a growing national effort.

Still, too many issue campaigns and too many funders fail to fully grasp the respectful partnerships and movement-building essential to defeat corporate power and right-wing politics. If we are to make the kind of transformational changes America and the world need, the politics HCAN pioneered, a sharply strategic national campaign built on empowering people through organizations around the country, points the way. 

Cross-posted from Next New Deal