One Extraordinary Sunday

Sunday, March 21st, was one of those days that remind you how non-linear change is in our crazy mixed-up Democracy. At five o'clock in the afternoon, as the House of Representatives inched toward a final vote on health reform, many of the estimated 200,000 people who were on the Mall to breathe life into immigration reform streamed up and around the Capitol. These were mostly young Latino families, many waiving or draping themselves in American Flags. It was surreal watching the immigration march - which was virtually invisible in the media (not unlike its protagonists) - flow around the several hundred people protesting against and for health reform.

I watched an older Anglo women lecture (in Spanish) a group of young Latino men, who were sitting on the wall, behind the Capitol about the evils of Obama-care. "Obama-care is Communism. You didn't come to this country for Communism, you came for liberty." One man replied, "Ma'm, I'm not a citizen, so I don't think I can tell Congress what to do about health care. But let me become a citizen and then I'll take a position." Suffice to say, there wasn't a lot of persuasion taking place.

As a community organizer, (saying that used to provoke blank stares, now it feels like picking a fight) it was a bit odd to be escorted through the protests into the Capitol Building to watch the final vote from the Speaker's box in the House Gallery. A year earlier, during the final vote on CHIP re-authorization, I'd sat in the same spot with Rev. Heyward Wiggins, who pastors an inner-city church in Camden, New Jersey. Rev. Wiggins co-chairs PICO's National Steering Committee and has led our work on health reform. It was hard not to feel a bit vindicated, those of us who argued against much opposition that a victory on covering children would be an ideal stepping stone for broader reform, rather than an excuse for putting off the fight for universal coverage (it is nice to be able to use the word universal again).

It was quite an experience watching the social interactions among members and staff on the floor. You see how important senior staff are to the process; and how divided the chamber is physically and how much rancor there is between Republicans and Democrats. The Republicans were clearly frustrated and angry; and the Democrats were celebrating. Speaker Pelosi looked thrilled. She was able to round up the votes plus a bit of a cushion ahead of time, so the Leadership avoided what many people expected to be intense arm-twisting on the floor leading up the vote.

As the President said last month, after a year of debate, almost everything that could be said about health reform has been said; so much of what was being said on the House floor echoed the talking points that we've heard all year. I thought Rep. Debbie Wasserman Shultz broke through emotionally when she talked about being a breast-cancer survivor and what reform would mean for women like her who have life-threatening pre-existing conditions.

The high emotion of that day reflected the reality of how close reform came to failing. Doubt is an unavoidable emotion. Avoiding death is an exhilarating experience. As organizers, we believe that social change happens when people realize how much power they really have. Coming up short on an organizing campaign (which almost always happens at some point) teaches us that we need more power; winning teaches us that we are more powerful than we ever thought. The moral arc of the universe bends toward justice because we bend it as we grasp the power that comes from being human.

The fight to make health care a right in the United States spans generations. In 1965, a gifted President committed to lifting people out of poverty met up with a Civil Rights Movement at the height of its influence to create a remarkable environment for large-scale legislative change. In the course of less than a year, Congress passed Medicare (and Medicaid) which broke the link between aging and poverty for tens of millions of Americas; the Voting Rights Act, which institutionalized the political liberation of African-Americans in communities across the United States; and the Immigration and Naturalization Act, which ended racial quotas in the immigration system and opened the doors of the nation to a generation of immigrants from Asia and Latin America.

In the 45 years between 1965 and 2010, Americans grew to love Medicare, but progress toward truly universal coverage was incremental and uneven at best. Congress took important steps to expand the Medicaid program to cover more poor families; and in 1994 it created the State Children's Health Insurance Program. Mostly, though, there were failures, most spectacularly the Clinton health reform debacle in 1993-94. As Health Care Economist Len Nichols has said, not a single soul was covered as a result of the Clinton reform effort, and perhaps as many as one-quarter million people died prematurely as a result of that failure.

Between 1994 and 2004, most of the action was at the state level, as state advocates and organizers and state governments used Medicaid and SCHIP to cobble together initiatives to expand health coverage. Our PICO network's involvement in the health reform movement began during these years, as our affiliates responded to the growing number of uninsured families by joining with advocacy groups to fight for more funding for safety net clinics; and to help create the first county programs that provided truly universal coverage to all children, regardless of income or immigration status.

The media is not good at history and is virtually incapable of covering the patient, sometimes very impatient, work of building the foundation for the kind of fundamental change that took place two weeks ago in Washington, DC. National health reform rests on the foundation of years of local and state organizing and advocacy.

There is no way that PICO could have participated in any meaningful way in the national health reform debate without first having worked to pass a strong children's health insurance bill, and there is no way we could have done that without the policy analysis by Georgetown Center for Children and Families, and so much other support we received from the Center on Budget Policy and Priorities, Community Catalyst and other organizations.

After the vote we sent out a thank you note to our grassroots leadership, thanking people for all of their work, especially their laser-like focus on affordability for lower-income families. We did not get everything we wanted in health reform, but the late addition of $122 billion in additional subsidies to lower premiums and out-of-pocket costs for lower-income families; the increase in primary care provider payments in Medicaid; the $12 billion in funding for Community Health Centers and the continuation of CHIP through 2019 were all important improvements in the final bill that will make reform work better for low-wage working families, which has always been PICO's primary reason for being in this debate.

A right to health care in America is no small thing. But we know that between organized campaigns to repeal and undermine reform and recalcitrant insurance companies, our work is cut out for us in the coming months and years. As we learned from the Civil Rights Movement, redeeming the right is always more difficult than winning the commitment.

On Tuesday evening, after the signing ceremony, I was at CVS arguing on the phone with my insurance company to get them to cover medication that my son's pediatrician had prescribed for a really bad rash. Blue Shield insisted they could not cover it because there was a different cream (not a generic) that was cheaper and they believed worked as effectively. After asking to speak to a supervisor and explaining that the doctor's office was closed and I wanted to get my son moving on the medication tonight, I found myself saying (not too politely), you are standing between my son and his pediatrician. I was given a "pay and educate" lecture, which I had no patience for, but felt empowered (perhaps by health reform) walking out with the medicine. When I came home and told the story to my son, he asked, "Why did that happen, I thought President Obama signed health care today?"