CLEVELAND — Tim Faust is getting worked up. Standing in front of a small crowd on the second floor of a Cleveland library, he’s starting to shout as he describes the poor rankings of American health care compared to those of the rest of the developed world. His presentation bounces around from academic studies to anecdotal horror stories about those who have had the misfortune of falling ill in this country, all with more f-bombs than you would expect at an otherwise staid event on health policy.
The event is a town hall sponsored by the Cleveland chapter of the Democratic Socialists of America (DSA) to explain Medicare for All, the proposed expansion to the rest of the population of the half-century-old system that pays for health care for people over 65. When Republicans attempted to repeal the Affordable Care Act (Obamacare), it inspired a backlash across the country, with support growing for a program with an embattled history. With the replacements projected to leave millions of Americans without health care, GOP lawmakers confronted feisty crowds in traditionally red areas.
Faust is one of the most prominent of a band of activists who have rallied to the cause of expanding health care, which for him means going beyond Obamacare to the kind of single-payer system — the single payer being the federal government — proposed by Sen. Bernie Sanders, the Vermont independent, in a bill he introduced last year. But Faust also has a broader vision of “health justice,” which goes beyond simply paying for doctor’s visits to dealing with everything that affects health, such as nutrition and environmental pollution. He is one of the most visionary and visible of the activists advocating reforms, not just at the national level but increasingly in states where Republican administrations have refused to participate in the expansion of Medicaid authorized by the Affordable Care Act.
By Faust’s count, Ohio is the 31st state he’s visited since last summer, when he began his tour to evangelize the country, a traveling preacher attempting to spread the gospel of health care for all. The weekend before, he was in Louisville, Ky., and Bloomington, Ind., and the next morning, he’ll head to Buffalo, N.Y., for a quick speech before flying home to New York City, where he is a member of the local DSA chapter. It’s the fifth consecutive weekend he’s been on the road.
Whatever image you might have in your head of a single-payer activist, it is unlikely to match the 29-year-old Faust. He’s wearing a bandanna over his long hair and a T-shirt for Party World Rasslin’, the Austin, Texas-based wrestling league he helps manage. There’s also the occasional podcast about health policy and heavy metal bands with his girlfriend, who gifted him the container of lip balm shaped like a skull sitting in front of him.
Faust dove into researching health policy after canvassing in Florida during the 2013 ACA enrollment, after bouncing around California and Texas. Having to explain to people that they either weren’t quite poor enough or were the wrong kind of poor to qualify for care made him question how this system came into place, prompting the years of research that have made him one of the left’s favorite health care activists.
In 2016, he gained some notoriety by selling a “Ted Cruz Was the Zodiac Killer” T-shirt, riffing on an internet joke that the Republican senator from Texas was a never-identified California serial killer. He raised $70,000 and donated it to West Fund, an El Paso, Texas, organization that helps low-income women obtain safe abortions. After an appearance on the popular leftist podcast “Chapo Trap House” he started receiving requests to speak. First, the invitations came from local DSA chapters, but in recent months, he’s also held events with Democratic congressional candidates in Arkansas and Indiana.
Faust views single-payer care as the first step toward his desired goal of health justice. His dream is a robust single-payer program that would also mandate the government to fix any systemic problems that were making people sick. Are the homeless going to the hospital due to exposure? Health justice would provide for the construction of housing. Are people malnourished because they live in food deserts where fresh vegetables are hard to come by? Health justice would subsidize affordable produce in those areas. Lead pipes contaminating the water in cities like Flint, Mich.? Health justice provides the mechanism for funding replacements.
As far as paying for it — the Sanders plan is estimated to cost around $1.4 trillion — Faust says the country is already shouldering the burden of paying for health care, either directly through premiums or via tax dollars as subsidies to insurance companies. There would also be potential savings from negotiating down costs for things like MRIs, which cost five times as much in the United States as they do in Australia. He also dismisses libertarian criticisms that the program would put too much power in the hands of the government. He argues that it’s better to give that power to democratically elected officials than to CEOs immune from public feedback.
Faust’s belief is that the less he talks about himself the better, and instead, he prefers to incorporate the tales of the people he meets on the road. He considers himself both preacher and witness, rewriting his speech every time he goes out on a new tour to better incorporate the horror stories he hears along the way.
“When I’m on these tours,” said Faust, “I wake up in the morning, I drive six hours. I give a talk, I go to a bar afterwards and then I go to someone’s house. And in that house, it takes about 20 minutes until that person shares with me the worst thing that has ever happened to them.”
It can wear on a person, even if that person is as enthusiastic as Faust, who says the “bombardment of suffering” has further radicalized him about the necessity of changing health policy.
“I pet my dog and I cry a lot,” said Faust on how he deals with his ever-growing Rolodex of despair, like the outbreak of hookworm — previously thought to be eradicated — in impoverished areas of the southeast United States. “I feel like s*** for days, but then I focus, write it down and try to pay it forward.”
But if Faust is correct that single payer is still at least several years off, that leaves a lot of uninsured people left hanging in the meantime. Eighteen states are currently dealing with a “Medicaid gap,” in which their Republican state governments chose not to use the ACA’s Medicaid expansion provision, which provides federal funds to help low-income Americans get health care. That leaves a group who make too much to qualify for Medicaid but not enough to qualify for subsidies to help pay for their insurance.
So in the face of recalcitrant legislatures, citizens have begun pushing for ballot initiatives to expand health care.
Idaho is one such state. A group called Reclaim Idaho hopes to get a ballot initiative expanding the program in front of voters in November.
The campaign began last summer, when Emily Strizich, her husband, Garrett, and their friend Luke Mayville traveled the state in an old green RV — which they affectionately dubbed the Medicaid Mobile — talking to people about potential health care options. Sensing there was enthusiasm for the program, the group launched the campaign to collect the 56,192 signatures required to get Medicaid expansion on the ballot.
“We’ll go into communities where people voted for Trump at 75 percent,” said Strizich, “but then 75 percent of the people will sign the petition willingly, with enthusiasm, and call their families to tell them they need to get down to the post office and sign this, it’ll help so-and-so.”
Strizich said she’s been reaching out to rural communities, despite the difficulty of going door to door where houses are miles apart. In these areas, the group has taken to setting up tables at grocery stores and post offices, and having canvassers attempt to gain support from people as they visit their Department of Motor Vehicles. It can be a compelling case, as rural areas are particularly affected when hospitals close, which has been happening more often in states that didn’t expand Medicaid.
Strizich was surprised to see the degree of interest in solutions that go further than the Medicaid expansion.
“There’s a lot of people that are really excited about universal health care, and a lot of people sigh and say, ‘I know this is a step in the right direction, but I really hope we get to a Medicare for All solution,’” said Strizich, laughing about her conversation with a group of pro-single-payer bikers. “It’s so interesting, because the people who say these things are not people you’d expect to say that, and that’s been so revealing to me.”
That the effort has been so successful thus far has been a surprise to some supporters. Dr. Dan Schmidt is a former Democratic state senator whose attempts to push Medicaid expansion through the legislature were continually rebuffed. The Idaho initiative is based on one of his bills.
“I met with these guys last year and I said ‘Good luck,’” said Schmidt. “Getting an initiative done in this state is really, really hard, and I’m not sure unless you can get half a million dollars and a bunch of people. They came back a few months later and told me they were going to do it and they wanted to see my bill. I showed it to them and again said ‘Good luck.’ But by January, they already had a very active statewide group, and I went, ‘Give me petitions, I’ll get signatures.’”
Assisting Strizich’s group is the Fairness Project, a nonprofit organization that pushes progressive ballot measures at the state level. The group is helping with Medicaid expansion in all four states that are considering it this year, helping them write the language of the bill and then assisting with the campaign until Election Day. Jonathan Schleifer, executive director of the group, is optimistic.
“Every attempt to repeal the ACA increasingly clarified two things for Americans: what was at stake for them and their families and just how committed opponents of the ACA were, even if it meant millions losing coverage and personal costs skyrocketing,” said Schleifer. “It became clear to Americans that they could not count on D.C. nor their statehouses to do the right thing. So they decided to grab a clipboard and take their future into their own hands.”
The organization found success in Maine last fall, when 59 percent voted yes on a Medicaid expansion that would provide health care to an estimated 70,000 low-income residents. It’s a result that provided encouragement to other states considering similar action.
“Maine was a bellwether for the states that were looking to do Medicaid expansion through signature collection,” said RyLee Curtis, the campaign manager for Utah Decides, which is seeking health care coverage for 100,000 low-income Utahans. “They were definitely a bellwether with whether this could be accomplished. We were supermotivated by the success in Maine.”
But it wasn’t an easy choice in Maine, as organizers had gathered signatures at polling stations on Election Day 2016 on the assumption of a Hillary Clinton victory. When Trump won and the future of the ACA was called into question, the debate became whether it was more important to push for Medicaid expansion or to lobby Sen. Susan Collins, R-Maine, whose vote on the repeal was decisive. If the ACA repeal had been successful, the Medicaid expansion would no longer be offered to states, making the work of pushing a ballot initiative useless. According to Robyn Merrill, co-chair of Mainers for Health Care, the answer was to do both.
“The takeaway is to have an alternative vision and not just be saying no to bad, harmful things,” said Merrill, “but really trying to move and advance good things that are going to make a difference for people. Ultimately, when we do that, we win on the issues, because we’re on the side of people. And when it comes to health care, most people recognize that the system is broken, we need to be doing better, and could really understand and get that Medicaid expansion would be good for our state.”
Like Strizich and her fellow Idaho canvassers, Merrill found the best argument to make was two-pronged, pointing at the human impact (70,000 more people with health care) and the economic impact (an infusion of federal money that would create jobs and help keep hospitals open).
With the May 1 deadline passed, people involved in the Idaho campaign said they’re confident they’ve cleared the target number by a few thousand, but that it could take up to 60 days for the individual county clerks to verify the numbers. In neighboring Utah, the campaign to get Medicaid on the ballot there announced Friday that the counties had verified enough signatures to clear the 113,000 needed to get on the ballot. The Utah measure would use a 0.15 percent increase in the state sales tax to help fund the measure. The deadline for signature drives in Montana and Nebraska are later this summer.
Even if the ballot measures pass, there are potential roadblocks. In Maine, despite the passage of the referendum by an 18-point margin, Republican Gov. Paul LePage has refused to expand the program. Declining to implement the program until Maine’s Legislature provides funding — federal funding initially covers all of the expansion cost, but that eventually transitions to 90 percent funding — the LePage administration is now involved in a lawsuit with pro-expansion groups. GOP candidates for governor in Idaho, including U.S. Rep. Raúl Labrador, have said they might not implement Medicaid expansion, even if it gets on the ballot and passes. The federal government is also undermining the program by granting waivers to states to implement changes such as time limits, work requirements and drug tests.
But there are reasons for those pushing for expanded health care to feel positive. The ACA polled at the highest levels in its history following the repeal attempt, while enthusiasm for government involvement in health care also rose. Several Democratic senators seen as potential 2020 presidential candidates — Cory Booker, Kirsten Gillibrand, Kamala Harris, Elizabeth Warren — are co-sponsors of Sanders’ proposed single-payer plan. And resistance might be at least temporarily wobbling: Republican lawmakers who made Obamacare the focal point of multiple campaign cycles have largely dropped the issue, according to an analysis from HuffPost.
Since it would be impossible at present to pass a single-payer plan with Republicans controlling Congress and the White House, health care advocates still have plenty to push for between now and November. In Maine, they are trying to force the state to implement the results of the referendum. In Montana and Nebraska, they still need to gather tens of thousands of signatures in the coming months. For groups in Idaho and Utah with signatures already submitted, it’s about continuing the conversation with residents and preparing for attacks from opposition groups.
And for Faust, it’s continuing his tour, with a goal of hitting all 48 of the continental United States by the end of the year. He’s dropped out of the health policy master’s program he was enrolled in at New York University (“It didn’t make sense to pay $15,000 to read stuff I was reading for fun anyway”), but is working on a book about the path to single payer. But the focus on health justice doesn’t mean he isn’t extremely supportive of activists working at the state level.
“Medicaid expansion is my platonic ideal of a policy on the way to single payer,” said Faust. “It offers mass relief to people who have been left behind by the ACA, and it offers it to a constituency who will fight to defend it and fight for the next thing.”
Faust relishes rattling off wins, whether it’s the effort in Maine, a needle exchange program in Cincinnati or a paid sick leave program in Austin, Texas, and he dismisses partial solutions such as an adjustment to insurance markets, a proposal put forth by the Center for American Progress, a Democratic think tank, last summer. These local victories are integral to Faust’s primary political theory: Give people something to fight for and that’s exactly what they’ll do.
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