"Obamacare" is showing surprising staying power, thanks in large part to doctors, hospitals and other health industry players opposing the alternatives that Republicans have proposed.
The stories and perspectives they bring to the debate are grounded in the local community and the impact on finances and well-being. But also their professional associations are deep-pocketed campaign donors and major lobbying powers on Capitol Hill.
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For the providers, coverage gains and expanded benefits under the Affordable Care Act, or ACA, translate to better chances of keeping patients healthy, and fewer unpaid bills. They say such tangible results outweigh the shortcomings of the Obama-era law, which extended coverage to millions previously uninsured but remains politically divisive.
"We need to be constantly pushing to get folks to do a bipartisan fix of the ACA," said Sister Carol Keehan, president and CEO of the Catholic Health Association, representing more than 600 hospitals. "We have to keep blocking and tackling until we get there."
According to the nonpartisan Center for Responsive Politics, the health care sector was the sixth largest source of political contributions in the 2015-2016 election cycle, giving more than $268 million. Health care ranked ahead of lawyers, labor, and agribusiness. The industry split its contributions fairly evenly, with a slight edge in gifts to Democrats.
Recently the American Hospital Association, the American Medical Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association all have written congressional leaders warning of negative consequences to patients if the GOP bill becomes law.
Patient advocacy groups like the American Cancer Society Cancer Action Network, the American Heart Association, the American Diabetes Association, the American Lung Association, the March of Dimes and others are raising similar concerns.
Such groups by and large supported passage of Obama's law, but they also recognize its problems of complexity and cost, and are willing to support changes as long as coverage is maintained or keeps growing.
For the American Medical Association, the focus has been on reaching Republican moderates in the House, whose concerns seem to be the last obstacle to advancing the GOP health care bill.
A Wisconsin nonprofit called the Marshfield Clinic provides an illustration of the provider playbook on Capitol Hill. Marshfield is a large private medical group practice with more than 700 doctors serving the northern part of the state. It also operates hospitals and an insurer called Security Health Plan.
Marshfield representatives have met with House Speaker Paul Ryan, R-Wisc., health secretary Tom Price, and members of the state's congressional delegation. Not only is Marshfield a health care enterprise, it is also a major local employer.
"The biggest concern we express is that we have made many gains with the ACA as it exists today," said Marshfield CEO Susan Turney. "We are particularly concerned about what's happening with pre-existing conditions."
The latest drafts of the GOP bill would allow states to obtain waivers of the ACA provision that requires insurers to charge people with medical problems the same premiums that the healthy pay. Consumers who've had a break in coverage could be charged more.
Among the gains Marshfield representatives cite are 30,000 "Obamacare" customers covered through the system's insurance plan, nearly all of whom receive subsidies. Marshfield's burden of unpaid care has also been dramatically reduced. In 2012, the system treated 13,277 patients who were uninsured. That was down to 6,948 last year, nearly cut in half.
Hand-in-hand with such statistics come stories about patients. On a recent round of congressional visits, a Marshfield doctor told of a local knitting shop owner who had lost her vision in one eye. Had it not been for coverage under the ACA, the patient might have lost the use of her other eye as well.
"Being a physician and taking care of patients, these stories are repeated," said Turney.
Similar stories can be heard from the most remote parts of the country. John Cullen is a doctor in Valdez, Alaska, supporting efforts by his professional organization — the American Academy of Family Physicians — to maintain coverage gains from the Obama era.
His community of 4,000 people is the terminus of the Trans-Alaska pipeline. While refinery workers tend to have health insurance, fishermen and their families traditionally struggle to afford it. Before "Obamacare," uninsured people would put off medical attention until problems could no longer be ignored. The consequences and costs would inevitably be higher.
"If I can see them in the clinic and treat something early, it's really cheap," said Cullen. "If they come in for high blood pressure or cholesterol, that can be treated with medication. But if they're coming in with a heart attack or a stroke, you have to transport them to Anchorage. Transport alone is $27,000 to $70,000."