How grassroots activism

Talia Robledo-Gil was walking between meetings on Friday, March 24, when her cell phone signaled a news alert from The New York Times. The Republican leadership in the U.S. Congress had cancelled a vote to repeal the Affordable Care Act (ACA).

“I had to read it twice,” Robledo-Gil said, recalling her shock at the news. “This is really happening. The ACA is the law of the land.” Soon her phone was exploding with texts from other students at Yale who had spearheaded efforts at Yale to save ACA. “It was re-energizing,” said Robledo-Gil, a fifth-year medical student.

For months she and about a dozen classmates, under the banner of the Yale Healthcare Coalition, as well as the national #ProtectOurPatients movement, had held rallies, organized phone banks to contact politicians, encouraged classmates to write opinion pieces to their hometown newspapers, and met with Connecticut senators and congresspeople. The students launched their efforts at a meeting at the Yale Law School in November that brought hundreds of members of the Yale community together in response to the election of Donald Trump as president. Throughout his campaign Trump had promised to repeal the ACA as one of his first acts as president.

“While we all agree that the Affordable Care Act is imperfect, we felt strongly that the American Health Care Act proposed by House Republicans was unacceptable,” said medical student Andi Shahu. Repeal, he said, would have taken coverage from 24 million Americans over the next decade, and made health insurance unaffordable for poor and older Americans. “Many of our patients fall into this category. We felt that an ACA repeal would harm our current and future patients.”

With the collapse of the repeal effort last Friday, blame has fallen largely on conservative Republicans who insisted on total repeal, as well as more moderate Republicans who feared the effects of repeal on their constituents. Then there was widespread dislike of the plan—a Quinnipiac poll showed it had the support of only 17 percent of the public. Grassroots activism across the country also played a key role in blocking the repeal. Over recent weeks, members of Congress had heard at town hall meetings and through countless phone calls and emails from people who depended on the ACA for health insurance. Medical students around the country, and at Yale, were part of those grassroots efforts.

“We learned that grassroots political activism works,” said Shahu. “We have realized how much the voice of medical providers matters in this conversation.”

Echoing that sentiment, Karri Weisenthal, also in her fifth year, said that speaking out and giving voice to patients is a moral imperative for health professionals.

“We hear stories every day from our patients that coalesce into a dataset on the state of health care and the effects of health care policy in the United States,” she said. “We have a choice to make: do we keep it hidden by staying silent for fear that we may sound political, or do we allow those making policy decisions—both the politicians and the American public voting for them—access to this data by speaking out, advocating, and writing op-eds?”

“I’m incredibly heartened by what happened last week,” said Priscilla Wang, who’s graduating in May. “It justifies our stance over the past couple of months.”

That stance, Wang said, put the students at odds with medical societies that seemed to accept the inevitability of repeal.

“I couldn’t understand why the fight was being conceded before it even began,” she said. “We were told by medical leaders that repeal was essentially a done deal due to the winds of politics, and that our proposed message of ‘no repeal at all’ would come across as naive and prevent us from getting a seat at the negotiating table.”

Despite the apparent victory for the ACA, the students agreed that the fight is not over. “We have a president who has indicated he is just as happy to allow the ACA to crumble in on itself,” said Weisenthal.

Students also said that medical curricula should include studies of health policy, the health care system, and current events. Because their advocacy efforts connected them with medical students around the country, Wang said, they learned that many felt unable to advocate effectively because they lacked a strong grasp of health policy.

“Shouldn’t we be very concerned if those in the medical profession can’t effectively discuss how our health care system works, and aren’t able to speak out against a bill with dangerous national consequences for their practices and patients?” she asked. “The political debate over access to health care is certainly not going away—let’s make sure the next generation of physicians is informed and prepared to advocate and speak up.”