Yes, Jan. 6—the day that a white supremacist mob overran the U.S. Capitol, ending in the loss of at least five lives—was a horror show, and one that will very likely not be soon over.
But the day’s nightmare also eclipsed two very good pieces of news, namely that Democrats Jon Ossoff and Rev. Raphael Warnock both won their Georgia races for the U.S. Senate. Warnock made history as the first Black Georgian elected to the Senate. That means that President-elect Joe Biden and Vice President-elect Kamala Harris take office Jan. 20 with (admittedly narrow) Democratic majorities in both the House of Representatives and the Senate.
And that means, for the first time since the first two years of President Barack Obama’s first term back in 2008 to 2010, Dems actually have the upper hand to pass legislation that can hugely benefit people living with HIV and other chronic health conditions—both populations that overlap hugely with traditionally vulnerable populations, including Black people and other people of color, as well as LGBTQ people.
Plus, this opportunity comes not only as the COVID-19 pandemic cripples the nation physically and economically, particularly impacting Black and Brown people, but as we reckon with the unfinished business of racial inequality in the wake of last summer’s massive protests against the police murders of George Floyd and other Black Americans.
The stakes are high, to say the least—and advocates know it. “We have the opportunity to make substantial gains toward ending the AIDS epidemic and advancing social, economic, and racial justice in this country,” says Charles King, the longtime head of the New York City HIV services and advocacy agency Housing Works.
Nobody disagrees with that. The question now is: With congressional margins being so thin, how do Dems play the congressional chessboard in a window of opportunity that may be as short as 2021, given that in 2022 boldness will diminish as lawmakers start worrying about the midterm elections? What should they go for first, and how? In standalone bills that require 60 votes in the Senate, or as part of so-called budget reconciliation, which allows the Senate to pass things that either raise or draw from revenues with a mere 51 votes (the current Dem majority)?
It all makes for a delicate balance between parties—and between perceptions of aggressiveness and moderation. “We have to be careful not to disparage our own allies to the point where they feel deflated or the other side feels emboldened,” says advocate Mark Hannay, who heads Metro New York Healthcare for All.
“Yet, at the same time,” he continues, “we have to push them as best we can to go as far as they can. The political dynamics are precarious because of the thin majorities, and they’re also fluid—things are going to change day to day.”
COVID Relief Must Come First
The consensus of most advocates seems to be that Biden and his Democratic Congress must prioritize the passage of a huge bill offering COVID relief. That includes everything from those $2,000 per household checks and ongoing unemployment insurance (including for undocumented people who were shut out of last year’s aid) to substantial help for COVID-ravaged states and localities that are facing—or already falling off—a fiscal cliff, as well as help for small businesses and COVID vaccine distribution efforts.
And they say the bill should be on the $3 trillion scale that House Democrats passed last spring but that Republicans in the Senate, under Mitch McConnell’s leadership, continually blocked.
“The most important thing that Biden, [Senate majority leader] Schumer, and [House majority leader] Pelosi must do is to get an adequate relief package out to the American public,” says Jaron Benjamin, Housing Works vice president for national advocacy. “It’s something their predecessors failed to do. Other items are important, but there’s risk associated with doing anything else first.”
And, generally speaking, advocates say that congressional Dems should try to pass this as a standalone bill, apart from budget reconciliation, because it is the fastest way to get it through, as soon as by March 15, and because there are very likely enough Senate Republicans to get to the needed 60 votes.
“Look at all the states that are being devastated right now,” says King, arguing that red as well as blue states are hurting. Matthew Rose, head of U.S. policy at Health GAP, agrees: “Everyone knows it’s going to be the Republicans’ fault [if no COVID bill goes through]. There’s huge pressure on them to deliver something after making people hurt for so long.”
He joins Hannay in saying that Democrats should put a big, bold bill out there immediately “and then dare the Republicans to defy it.”
So Then What?
Once a COVID package is (presumably) passed, say advocates, it’s then time to use budget reconciliation to push through stuff that only needs a 51-person Senate majority. (With that 51st vote very likely often coming from Harris, she’ll already have one way of forging a higher profile for herself than a vice-president might typically have.)
Advocates say that at the top of the list is the addition of a Medicare public option to the Affordable Care Act—allowing people the option of buying (at a reasonable price) into Medicare instead of a private ACA market plan, whose ever-rising costs and often limited coverage have been the top critiques of the entire ACA, otherwise known as Obamacare.
“We won the verbal commitment to a public option from Biden during the presidential campaign,” says Jennifer Flynn Walker, senior director of mobilization and advocacy at the Center for Popular Democracy, who—along with Benjamin—played a major role organizing yearlong protests in 2017 that helped (just barely) save the ACA.
“That’s huge,” she says. “Now we have to go out and get it, because the ACA is not going to continue to function”—due to successful Republican efforts to stop non-ACA-buyers from paying a penalty tax—“if we don’t fix it with a public option.”
And, points out Rose, not only is the ACA “unstable” and “damaged,” but “you need a public option because people in states that refused to expand Medicaid coverage under ACA [from the very poor to the moderately poor] need somewhere to go. Plus, unemployment is so high right now from COVID. Many people have lost their job-linked coverage. The situation is untenable right now without a public option.”
But on a goal inching toward the great American bogeyman of “socialized medicine,” is it possible to get it even to 51 votes—especially given that decade-long West Virginia Sen. Joe Manchin is often a spoiler for his own Democratic party?
Advocates think so, because the difference could be made up by a handful of moderate Republicans—such as Alaska’s Lisa Murkowski, Maine’s Susan Collins, and Pennsylvania’s Pat Toomey—all of whom realize that COVID has created a more dire health care situation for Americans.
One thing that advocates are not especially optimistic about happening during a Biden administration, however, is Medicare for All—that darling of Sen. Bernie Sanders and other progressive Democrats—which in effect would be total universal health care in the U.S. and an end to the primacy (if not the entire existence) of the private health insurance market.
“Ultimately, it’s what our communities need,” says Naina Khanna, executive director of the Positive Women’s Network, who wants to see this Congress go for it.
But Rose has a dimmer view. “Are you going to get floor action on it in Congress? Probably not. And I say that as someone in the nationwide Medicare for All coalition. The Senate’s not interested in it. You’ll never get 60 votes on it. And Biden wouldn’t sign it anyway. But you have to keep refining and winning the argument for it.”
And King thinks that showing the success of a Medicare public option is an important step in that direction. “Let’s get that expansion and see where it goes,” he says.
Flynn Walker says that if we can pass both the public option as well as a lowering of the age for Medicare from 65 to 60, another idea Biden has nodded to, “then we’re actually most of the way toward a single-payer system.”
But There’s So Much More!
Indeed, there is! Specifically for people living with HIV, Khanna says she wants to see a Dem-led Congress push the REPEAL HIV Discrimination Act, which would take laws still existing in many states criminalizing people with HIV who have sex without disclosing their status, and modernize them to reflect scientific confirmation in the past decade that people with HIV on treatment, whose virus is undetectable on labs, are unable to transmit HIV to sexual partners. And Jesse Milan Jr., who heads AIDS United, says it’s a priority that Congress expand and fully fund HOPWA (Housing Opportunities for Persons With AIDS) and the Ryan White CARE Act, bread-and-butter programs for people living with HIV that have long enjoyed bipartisan support even if they’re never funded at levels community members would like.
And then, of course, there’s hope to see progress on countless broader efforts that impact people living with, or at risk for, HIV. Those include everything from once again lifting the ban on federal funding for syringe exchange to getting the Department of Justice, newly staffed under Biden, to stop fighting efforts to legalize overdose-prevention sites (where people can inject street drugs under medical supervision).
Then there are bills that would strengthen antidiscrimination protections for LGBTQ people, create green-economy jobs in low-income Black and Brown communities, and move funding from policing to various forms of community services. Then, let’s not forget immigration reform and getting statehood for overwhelmingly Democratic Washington, D.C., which would likely give Dems two permanent new Senate seats.
That progressive wish list goes on and on. But how much—and how hard—should Democrats push? It’s a question that’s linked, inevitably, to ones that King asks: “Almost two years from now, come the midterms, are Americans going to do the usual thing and vote against the president’s party, or punish Republicans for what has taken place over the last month or so [with efforts to block Biden’s inauguration or not sufficiently punish Trump and others for the Capitol siege]? In the Senate, an overwhelming majority of the seats that must be defended are Republican. Can Biden win an even larger majority so that Manchin can’t hold a veto?”
Despite the uncertainty of 2022, many advocates think Democrats should push as hard as they can right now. “We really need to go bold on these issues of justice and equality,” says Khanna. “A lot of people around the country do want change, and Democrats ultimately have more chances of picking up long-term power by advancing a progressive agenda.”
In more strategic terms, Flynn Walker thinks Democrats should push as much of that agenda as possible in standalone bills at first, then move to the second tier of getting as much as possible into budget reconciliation.
“Let’s start by being aggressive and actually trying to pass things,” she says. “We’re all angry and need some kind of relief. Jobs have been lost. People who’ve gone to the hospital with COVID who’ve survived are being hit with enormous surprise bills.”
There’s also the tricky matter of impeachment. In early January, Democratic Congressmember Jim Clyburn suggested that the House might wait as long as 100 days into Biden’s term to deliver articles of impeachment against Trump to the Senate for a trial, which could lead to Trump being barred from ever running for office again, a major goal among all Democrats and many Republicans.
Clyburn urged that Biden be given a window of time to accomplish urgent agenda items, such as a COVID bill, before saddling the Senate with a trial, which basically halts all other Senate business until it concludes.
Khanna says she thinks impeachment should happen right away. But other advocates say they see the sense in waiting, although perhaps not as long as 100 days.
“At some point,” says Rose, “you have to hold people accountable and show that justice is swift and meaningful. You can’t just let all that go.”
Guess What? Your Job Isn’t Over!
But however congressional Democrats decide to thread the needle, advocates agree on one thing: People living with HIV, and all Americans, still have a huge role to play in putting air in the sails of Biden-Harris and Congress. The more the administration and legislators can say they are responding to the demands of their constituents, the more power they have.
In other words, if you thought that the days of your frenzied rallies, phone calls to lawmakers, and town hall hecklings back in 2017 and 2018, when you may have been among those trying to save Obamacare or keep Supreme Court Justice Kavanaugh off his seat, are over—think again. You just get to be slightly less terrified this time around.
“A sad truism in U.S. politics is that if your party wins, you become complacent,” says King. “But we have no room for that, given the seditionist energies within the Republican party. We need to look like 2016-2017 all over again, but not out of despair. We know the strategies that work. We saw what turned the tide in Georgia. Now we need to keep applying those lessons forcefully. We should be aggressively communicating with our own legislators and engaging in direct action to build public support” for all the legislative items we hold precious.
At AIDS United, Milan urges that people attend the organization’s AIDS Watch 2021, the HIV community’s annual agenda-setter and D.C. lobby day, to be held virtually this year. “It will provide education and opportunities to meet with the office of your members of Congress,” he says. “If you can’t attend, call and write your members of Congress. Tell your story. If you live in a state that hasn’t expanded Medicaid, push your governor and state representatives to do so. Syringe access is both on a federal and state level, so push for syringe access if your state puts up barriers to this proven harm-reduction method.”
And Flynn Walker urges readers to tap into efforts to move legislation forward in the coming months via channels including local chapters of groups like Indivisible, Move On, Public Citizen, or the Center for Popular Democracy’s Action League, which she says can be joined by emailing email@example.com.
“One nice thing about COVID,” she says, “is that you don’t have to go to D.C. and get arrested. You just get on a Zoom together with your organizing group and invite a senator.”
Democrats must have wins this year, she says. “If they don’t pass anything, people are going to say, ‘Gee, we let them have all three things—the White House, the House, and the Senate—and they still couldn’t achieve anything. Maybe we were wrong.’”