We are a group of 30,000 former White House officials, policy experts, medical professionals, and concerned citizens who want to share our strategy for how every American can help save our health care.  Join us: RISE Stronger    www.risestronger.org    DownloadPDF

Overview:  Our nation is gearing up for one of the biggest policy fights of our time.  This fight will be won at the grassroots by regular Americans.  THIS IS A WINNABLE FIGHT.  The Republican strategy is weak, but we need everyone in the fight.  Here is our strategy to win.

Step 1: Learn the Weaknesses of the Republican Repeal Before Replace Strategy.  While Republicans try to project confidence, the truth is that their health care strategy has serious flaws.  They won’t admit this, but they can’t get the votes to replace the Affordable Care Act (they need 8 Democrats). Since they can’t replace it, Republicans have added an unnecessary and reckless step called “Repeal,” which they know means many Americans will suffer.  They want to manufacture a crisis to gain political leverage. This must be stopped.

Step 2: Know When to Make Our Stand.  The best chance to save our health care is to delay and disrupt the process leading to the Repeal vote.

Step 3:  Target Republican Members of Congress Who Might Oppose the Repeal Before Replace Strategy.  12 Republican Senators have expressed concerns about rushing to repeal.  If 3 of these 12 Senators oppose Repeal Before Replace, then the Republicans will fail.  

Step 4: Find and Mobilize Everyone You Know in the 10 Battleground States.  We need to build armies in Alaska, Arizona, Kentucky, Louisiana, Ohio, Pennsylvania, Maine, Nevada, Tennessee, West Virginia.

Step 5: Launch a 30-Day Campaign to Mobilize Your Community.  We have all seen the progress we can make when we band together to strive for a common goal.  Together we can win this fight.

Step 6:  Sharpen Your Message.  Hone your ability to explain the benefits of the Affordable Care Act and the risks if it were to be repeal.

Step 7:  Think and Speak Local:  Craft a local narrative drawing on personal stories, facts about your state, and the financial costs to individuals and states if repealed.        

Step 8: Rally to Control the Tempo and Narrative in Your State’s Debate:  Make some noise and use rallies as ways to engage the media, Governors, State Representatives, health care organizations, hospitals, and other influencers.

Step 9:   Be Persistent and Relentless in Pressuring Your Member of Congress. Show up at town halls, request meetings, call or email.  No effort is too small; every bit counts.    

Step 10: Take the Fight to the White House: Starting January 20, take the fight to Trump.



The Republican Strategy is Built on Creating a Health Care Crisis that Puts Millions of Americans at Risk:  The Republicans have built their health care strategy on a myth -- that they themselves have the power to make sweeping changes to our health care.  That is a lie.  Republicans need 60 votes to replace in the Senate, which means they would need 8 Democrats.  Republicans know this is impossible, so they have created the fiction that they need to repeal before they replace.  That is a false narrative, and this strategy is anything but normal.  The step to repeal is completely unnecessary.  The normal process would be to just have one vote to replace the Affordable Care Act, which would skip the need to repeal.  The only reason they created this extra step to repeal is because they know they can’t actually replace the Affordable Care Act.  Think about it - why would they need to repeal something if they expected to replace it?  By creating this unnecessary extra step to repeal that will put millions of lives at risk, we can only presume that the Republicans are actively trying to manufacture a real crisis in hopes that the suffering of millions of Americans will motivate eight Democrats to vote for their Replacement.  This is a reckless gamble that threatens us all.

Here is the Republican strategy built over the course of THREE votes:

Vote 1:  Starting the Budget Reconciliation Process.  This is the vote that just happened in the Senate and the House on January 12/13.  While it passed both chambers, this vote didn’t change a single word of the Affordable Care Act.  All it did was start the budget reconciliation process.  This means that the relevant Congressional committees (listed below) are now instructed to begin writing the repeal bill.  


Health, Education, Labor, and Pensions (HELP) Committee

Finance Committee


Ways and Means Committee

         Energy and Commerce Committee

Each committee will run their own process to draft a proposal, which will need a majority vote in order to move forward.  The nonpartisan Congressional Budget Office (CBO) will also enter this process and estimate how much money the different proposals will save.  If the new plans don’t save any money, they won’t move forward.  Each committee needs to vote out a proposal, and a merger process will create one Senate bill and one House bill.

Vote 2:  The Actual Repeal Bill.  The reason the Republicans chose the Budget Reconciliation process is solely because it cannot be filibustered.  All the Republicans need to win Vote #2 is 218 votes in the House and 50 votes in the Senate (with the Vice President casting the tiebreaker).  The Republicans have 241 seats in the House (23 vote margin) and 52 seats in the Senate (2 vote margin).  If the Republicans stick together, they do not need a single Democrat to support.  If the vote is achieved, a conference committee process would reconcile the House and Senate bills, and both chambers will need to pass the unified bill, sending it to Trump to sign.

Vote 3: The Replacement.  This third vote would be the vote for the replacement plan.  We do not know when this third vote would take place.  Trump has said that the replacement bill will be introduced near simultaneously to the bill to repeal, but this is misleading.  The timing of the introduction of the bills is not the issue; the main issue is the timing of the passage of the bills.  As mentioned before, the replacement will need 60 votes, meaning they will need 8 Democrats.   If the Republicans successfully repeal the Affordable Care Act (Vote 2), the debate over its replacement (Vote 3) could take months if not years.  In the meantime, 30 millions Americans stand to lose their insurance in the interim.  

The Republicans will have us believe that the repeal of the Affordable Care Act is inevitable.  They are dead wrong. 


The best chance of stopping the charge to end the Affordable Care Act is to delay and oppose Vote 2 (The Repeal Vote).  If the Republicans cannot get to Vote 2 or lose the vote, the Affordable Care Act remains safe.  So this is where we draw the line and make our stand.  Steps 3 to 10 below lay out the strategy to delay and disrupt.  The longer the process, the more time we have to inform and organize Americans across this country to protect our health care.  

When to Make Our Stand:  Republican leadership want the committees to submit full proposals by January 27.  Frankly, that timeline will be very difficult to stick to given the sheer number of steps and hoops they need to jump through.  But in the event they are able to get bills to the Senate and the house by the end of January, that would potential set the votes to take place in early to mid February.  That date could slip to late February or even early March.  The longer the process, the more time we have to inform and organize Americans across this country to protect our health care.  That being said, we should be prepared in case the process moves faster.


The strategy here is not about trying to convince Republicans of the merits of the Affordable Care Act.  Instead, our strategy seeks to pressure Republican Members of Congress to confront the risks (for all Americans as well as their political careers) of repealing the Affordable Care Act without first voting and passing a replacement into law.  We should aim for one of three outcomes:

  1. Republicans conduct Vote 2 (Repeal Vote) and lose.
  2. Republicans push off Vote 2 indefinitely because they don’t have the votes and seek to take some measures through executive action.
  3. Republicans abandon Vote 2 altogether and seek to replace and repeal in the same bill (which would require 60 votes in the Senate to pass). 

If we achieve one of these outcomes, there is a chance that the Republicans will never have the ability or capacity to replace the Affordable Care Act.  The only way to accomplish any of these three outcomes is to target Republican Members of Congress who are wavering and might be convinced to oppose repealing through Vote 2.  Fortunately, there is a growing number of Republican Senators and Representatives that have expressed concerns about repealing the Affordable Care Act before having a replacement.  The fate of the Affordable Care Act is in the hands of these individuals. Who are they?  The current list is below (please let us know if others waver and we will update the list):



Alaska – Lisa Murkowski

The Freedom Caucus – A group of approximately 30 Representatives chaired by Mark Meadows (R-NC) have expressed strong concerns about rushing towards repeal.


The Tuesday Group – An informal group of about 50 Representatives have raised concerns about health care repeal.  Group co-chair, Charlie Dent (R-PA), voted against initiating the reconciliation bill process.

Arizona – John McCain and Jeff Flake

Kentucky – Rand Paul

Louisiana – Bill Cassidy

Maine – Susan Collins

Nevada – Dean Heller

Ohio – Rob Portman

Pennsylvania – Pat Toomey

Tennessee – Bob Corker and Lamar Alexander

West Virginia – Shelley Moore Capito


THE SENATE:  The 12 Senators listed above have expressed concerns about rushing to repeal.  Rand Paul even voted against Vote 1 to start the budget reconciliation process.  If 3 of these 12 Senators oppose Vote 2, then the Republicans will not have enough support to repeal the Affordable Care Act.  Targeting these Senators also provides another opportunity: recall that as a result of Vote 1, two committees are tasked with drafting proposals feeding into Vote 2.  Six of these senators sit on the two designated Committees.


  • Lamar Alexander (Tennessee and committee chairman)
  • Rand Paul (Kentucky)
  • Bill Cassidy (Louisiana)
  • Susan Collins (Maine)


  • Pat Toomey (Pennsylvania)
  • Bill Cassidy (Louisiana)
  • Dean Heller (Nevada)

Republicans control both committees by only ONE VOTE, meaning any one of these Senators could flip the vote on its head.  This provides a potentially important opportunity to delay the committee proceedings and also to potentially block or reject a vote at the committee level.

THE HOUSE:  Flipping the House vote will likely be harder than the Senate as 24 Republicans would need to vote against in order to flip the vote, but with so much on the line, we need to press on every angle we can get.  We don’t have as good of a sense of which members of the House are wavering, but the below nine Representatives voted against the Republican-led effort to start the Budget Reconciliation process (Vote 1).  Please email us at accounts@risestronger.org if you have information about additional Representatives to target.

Charlie Dent (R-PA)


Brian Fitzpatrick (R-PA)


Justin Amash (R-MI)

(202) 225-3831

Walter Jones (R-NC)


John Katko (R-NY)

(202) 225-3701

Raul Labrador (R-ID)

(202) 225-6611

Tom MacArthur (R-NJ)

(202) 225-4765

Thomas Massie (R-KY)

(202) 225-3465

Tom McClintock (R-CA)




  • Every Person Counts:  These states are the current front lines of the fight – the battleground states.  We only need three Republican Senators to oppose Vote 2.  Get the word out, share this strategy with them, get them to sign up and get active.  
  • If you live in these states Sign Up for Updates and Information for how you can get involved.  Do everything you can to bring together as many people in your community to engage your Senators by following the steps below.  Tell your Senators that you appreciate and completely agree with their concerns about repealing the Affordable Care Act before some alternative is in place.  Repealing without a replacement means that Congress is gambling with our lives, and that is unacceptable.  Urge them to stick to this principle and let them know that the way they vote on healthcare will determine how you decide to vote on them at their next election.  Then get everyone you know to relay the same message.


If you are not from one of the 10 current battleground states, there is still much you can do.  With an issue as explosive as healthcare, there is nothing stopping every state from becoming a battleground state.  Just ask Representative Mike Coffman (CO-6) who had over a hundred people show up at an event pressing him to explain why he wants to take away their health care (he had to sneak out the back door to escape).  Every day it feels like we are hearing more and more from rank and file Republicans raising concerns about repealing before replacing.  

Remember, our strategy isn’t about trying to convince Republican leaders to support the Affordable Care Act, it is about convincing Republican Members of Congress that they cannot and should not repeal before they replace.  That is a much more attainable goal and something that can potentially be achieved anywhere.  Nearly every, even deep blue states, have Republican Members of Congress, and Democratic Members of Congress can and should play a critical role in speaking out publicly and taking all actions in their capacities to delay a repeal vote.  

  • Join an Army:  Immediately begin to meet up in-person with groups and organizations in your area to discuss healthcare and to come up with a plan to pressure your Members of Congress.  We have only days/weeks to pull together one of the largest grassroots movements possible.
  • Find an Army:  If you have a group already set up or know of groups in your area, please send information to accounts@risestronger.org and we will include it in later versions of this guide.  You can connect with others around you through these groups RISE Stronger, Action Group Network, Indivisible  You can also visit the Protect Our Care coalition website.
  • Start an Army:  If you can’t find a group, start one.  Here is a great guide/tool kit on how to start a local group.


Suggested Talking Points

The Benefits of the Affordable Care Act:

  • The percentage of Americans with health insurance has reached the highest point in our nation’s history.
  • No one can be denied health insurance due to a pre-existing condition, which is a benefit to 52 million people who could otherwise be excluded.
  • 3 million more children have insurance than before, cutting the uninsured rate among children in half
  • Every woman is guaranteed free benefits for preventive and pre-natal services.
  • There are no more lifetime limits on insurance payouts, which is critical for people with severe chronic conditions.
  • Anyone can stay under their parent’s insurance up to age 26, which is currently helping 1.4 million young Americans.

If the Affordable Care Act is repealed before any replacement is in place:

  • The number of uninsured Americans could rise by 18 million in the first year alone, and could soar upwards of 30 to 32 million in subsequent years.
  • Nearly 4 million of the newly uninsured would be children.
  • Congress would be jeopardizing the health and financial security of millions of Americans as premiums would spike up to 20 to 25 percent in just the first year.
  • Insurance companies could go back to previous practices of charging women and the million of Americans with pre-existing conditions more.
  • 2.5 million jobs could be lost across all 50 states from the repeal, including 334,000 jobs lost in California, 181,000 in Florida, 175,000 in Texas, that will causes tens of billions in losses.  (More data about other states can be found here:  George Washington University Report)
  • These serious risks and dangers can all be avoided.  There is no reason the Republicans need to Repeal first.  If they have a better idea, then they should try to pass a law that replaces what we currently have.  Don’t gamble with our lives.


  • Craft a Narrative Specific to Your State and Community:  Work with your group to put the facts about the benefits of the Affordable Care Act and the risks of its repeal (Step 6) into your own words that will resonate with people in your state and community.  You aren’t going to convince or energize people in your area with binders full of national facts.  The most effective message will be one specifically crafted for your local community.
  • Learn How the Affordable Care Act Affects Your State:  Get facts and figures about your state, learn the nuance, and weave these facts into your message.   For instance, West Virginia, New Hampshire, and Kentucky, which have the highest number of drug overdose deaths in the country, are the states that are projected to see uninsured rates nearly triple if the Affordable Care Act were repealed.  Health and Human Services State by State website is the best resource we’ve found for this state-level information.
  • Make It Personal: Crafting a Powerful Story:  Health care is about stories.  We all have them.  We all know people close to us, or possibly even ourselves, who are or have been significantly affected by health issues.  Facts are useful and important, but stories are what brings us together and make us want to stand up and fight.
  • Share Your Story:  Tell your story to your community, to local groups, to the media.  Here are places where you can share your story online.  Protect Our Care Initiative   Department of Health and Human Services  Organizing for Action (barackobama.com)  Patients Action  Tim Kaine Website
  • Tell a Narrative That Rises Above Partisanship and Builds Bridges Between Diverse Communities:  Health care is about people, not political parties.  It should be nonpartisan.  All Americans have an interest in being healthy.  Stories from our own experiences are nonpartisan.  They are able to cross and transcend political lines and build bridges with other communities and individuals.  A great example is how life-long Republican Jeff Jeans confronted Speaker Paul Ryan about how Obamacare saved his life (Jeff now has a Facebook group for people to share stories).  If ever there was a political issue that could help us breakdown our silos and build bridges with different communities, it is healthcare.
  • Tug at Wallets In Addition to Heartstrings:  In addition to powerful personal stories that connect with people’s emotions and empathy, you should also craft a message that highlights the personal financial risks that repealing health care can have on millions of Americans.  Hospital systems will experience unprecedented financial loss and will need to cut hundreds of thousands of jobs, sending ripples throughout communities where hospitals are often one of the largest employers.  Small businesses, entrepreneurs, freelance and contract workers, and many others will suffer as well due to skyrocketing premiums.  A detailed report of potential job losses across states can be found here.   


  • Hold Public Rallies to Support Health Care (Possibly on January 27):  This can be just a few people or it could be a couple of hundred.  Choose a day that works for your team (possibly January 27, the day Republicans set to pick up debate in Congress).  Invite all of your Members of Congress, but don’t wait for them to organize something.  You control the tempo.  Try and connect with Protect Our Care, MoveOn.org, and other large advocacy groups to see what they are planning.  We can try and help you connect.  If they don’t have any rallies lined up, invite them to join yours.  
  • Consider Holding Your Rallies At Your Member’s Office:  An amazing thing is happening in Pennsylvania as hundreds of citizens are gathering at all of Senator Toomey’s offices at the same time every week - Tuesdays at 12:20pm during people’s lunch break - to ask to speak to Toomey or his staff.  “Tuesdays with Toomey” is becoming an amazing weekly event that has garnered impressive media attention, and you should consider replicating that model in your own districts/states.  The predictable time and place makes it easy for people to connect.
  • Urge Your Member to Hold Rallies and Town Halls to Raise Profile:  If you have a Member who already opposes the Republican push against health care, urge your Member to set up their own rallies, be publicly outspoken on this issue, and to engage with conservative communities within your own state, especially rural and working class communities who have a lot to lose if their health care is repealed.
  • Don’t forget about Engaging Governors and State Representatives:  While these officials won’t be at the epicenter of action, they have important voices in the states.  Focus especially on Republican Governors, especially those that express concerns about a rushed repeal, such as Governor John Kasich (Ohio) and Rick Snyder (Michigan).  Invite them all to your rallies.  Even if they don’t show up, they will at least know that you are holding a rally.
  • Invite People with Powerful Stories to Speak: When you find people who have powerful stories about health care (Step 7), invite them to speak at rallies, give interview to local press, and encourage them to write op-eds in local papers.
  • Invite Health Care Organizations, Networks, and Professionals To Get Involved:  Every state has a major hospital system.  Latest reports shows that hospitals nationwide could lose hundreds of billions of dollars in the event of a repeal without a replacement.  The American Hospital Association President said, "Losses of this magnitude...will adversely impact patients' access to care, decimate hospitals' and health systems' ability to provide services, weaken local economies that hospitals help sustain and grow, and result in massive job losses.”  Find groups of health care professionals and encourage them to join your rallies and speak to the crowd with authority from their expertise and experience.  They will be some of the most trusted voices.
  • Remember to Applaud Politicians in Addition to Pushing:  Remember that many Republican leaders, including the key Senators listed above, are taking a position that goes against Trump and Congressional leadership.  Applaud them when they make statements that stand up to Trump, push back when it looks like they are slipping. 
  • Let the Media Know What You Are Doing:  This is so very important.  The rally will only translate into significant and sustained political pressure if you can use it to boost media and social media attention.  Build out lists of reporters and other media sources in your area.  Write your own press release.  Get some community leaders or established organizations to be organizers so you can leverage their connections.  Build relationships with the media and let them know when and where you are planning to make a stand.
  • Document and Inspire: Always take pictures of your group gatherings and post these online.  Seeing photos of other Americans gathering is what inspires more and more people to rise up and take action.  Always post photos with information about how people in your area can join up with you.


  • Do Your Homework On What Your Members Have Said About Health Care: Use online resources to collect quotes that your Members have said as well as information about their voting record.  Create a shared Google Doc for you and your group so you can collect this information and share.  Some Resources:  
  • VoteSmart to find out voting record as well as positions on healthcare
  • GovTrack to find out bills sponsored by each member and voting record
  • Create Google Alerts for your Members’ names.  

  • Sign Up for Town Hall Notices: Call the offices of your Representative and two Senators and ask to be notified (usually an email list) about future town hall meetings.  Take the RISE pledge to go to a Member of Congress Town Hall.  Read the Indivisible Guide to learn how to best to pressure you Member.
  • Be Proactive and Request a Meeting:  Don’t just wait for your Member to hold a town hall.  Gather with members of your community to request an in-person meetings with your Member of Congress immediately (before the end of January).  Don’t let your Members ignore you.  Try and find out what other events your Members are participating in.  Show up in large numbers.  Show up at all of their offices.  Coordinate actions with others in your district/state.
  • If You Are Turned Away, Seek Media Attention Or Record and Share Videos Yourself:  As we mentioned earlier in this guide, when Representative Mike Coffman (CO-6) arrived at an event with constituents a few days ago, he found over 100 people who demanded that he protect their health care.  When he refused to meet with them all, local and national media amplified the voices of these angry constituents.  Having the cameras there helped broadcast this event far and wide, and it inspired many others to step up.  Video and photos are best, but you could also write a letter to your editor (guidance here)
  • Call Members of Congress Regularly and Frequently:  Set up a reminder on your phone to call your Members of Congress at least once a week, or multiple times a week!  Don’t be intimidated to call, as the calls are short and usually you’ll get a junior staffer whose job it is to record constituent opinion.  Dial 1-202-224-3121, enter your zip-code and be connected automatically to your Senator  Click here for: Senate Phone List         House Phone List

Suggested Script:  “My name is __________ and I am your constituent.  I want to express my strongest belief that the Affordable Care Act must be preserved.  Repealing the ACA without first passing some type of replacement or modification would be a reckless gamble with the lives of millions of Americans.  What is the Representative/Senator’s position on preserving our health care?

  • Don’t Take Blue States for Granted: Many Blue states still have Members of Congress who are Republicans.  Lend a hand and help these districts mobilize.   If you have a Senator or Representative on one of the key committees (see above in Step 1), press them to protect your interests when the committee drafts the proposals.
  • Reinforce Blue Senators in Red States:  In the event that Republicans start to lose votes, they will try to pull in vulnerable Democratic Senators.  Five Democrats in particular are potentially vulnerable as they are up for re-election in 2018 and are from states where Trump won by double-digits.
  • Indiana – Joe Donnelly                 202-224-4814
  • Missouri – Claire McCaskill                  202-224-6154
  • Montana – Jon Tester                  202-224-2644
  • North Dakota – Heidi Heitkamp          202-224-2043
  • West Virginia – Joe Manchin          202-224-3954



  • Find New Pressure Points:  We as citizens often focus almost entirely on engaging our representatives in Congress to raise our concerns, but our Executive Branch also feels the pressure of public opinion.  Starting January 20, we should also take our concerns directly to the White House and the Executive Branch.  
  • Let the White House Know How You Feel:  
  • Phone Comments: 202-456-1111 (though the line appears to be closed, and frankly could remain closed under Trump)
  • White House Contact Form:  https://www.whitehouse.gov/contact
  • Letters to:

The White House

1600 Pennsylvania Avenue NW

Washington, DC 20500

  • Pressure Department of Health and Human Services Leadership
  • Emails to the next Secretary of HHS -  scheduling@hhs.gov
  • Phone Numbers:  (numbers subject to change with new administration)
  • Assistant Secretary for Public Affairs (202) 401-2281  Phone number could change with administration
  • Principal Deputy Assistant Secretary for Public Affairs (202) 260-7177
  • Deputy Assistant Secretary for Public Affairs for Health Care (202) 260-6946

  • Respect the Civil Service:  Remember, the vast majority of the Department of Health and Human Services is made up of hardworking civil servants, many of whom might not agree with the policies and actions of their leadership and Congress.  If you end up speaking to one of them, be polite and express your thanks for the hard work they are doing.  
  • Let’s Organize Massive Rallies at the White House and at the Capitol:  It’s not just out in the Congressional districts that we need powerful grassroots energy, we need it here in DC to show our leaders that we are rising up to protect our health care!

SIGN THE PLEDGE TO COMMIT TO THIS TEN-STEP PROCESS.  Join RISE and we will send you updates on the fight ahead, updated versions of this plan as we get more and more inputs from you all, and give you more suggestions on how you can get more involved.   SIGN UP HERE TO CONNECT TO THE FIGHT


What other ideas do you have for how we can fight for our health care?  Give us feedback and tell us what else we as citizens can do. We will keep updating this guide with more resources based on your inputs.  Send us message and comments via Facebook at https://www.facebook.com/RISEStronger.org or email to accounts@risestronger.org  For more information or to join us, please visit www.risestronger.org

RISE Stronger is working to become the largest citizen watchdog organization in the United States with the mission of monitoring and responding to the Trump Administration, Congress, and state and local governments. We are a movement of 30,000 citizens who want to step up and be a check on our government and hold our public servants accountable.  We are all volunteers. Many of us have never met each other in person.  What unites us is that we care deeply about our government and the issues that affect each and every American, including health care.  Each of us carries raw and powerful stories of how health care, or the lack thereof, affected the life and death of our loved ones.  Everyone, absolutely everyone, gets sick. Everyone, absolutely everyone, should have the opportunity to get healthy.  Everyone, absolutely everyone, should have the ability to manage their sickness with dignity and care.  This isn’t about Obama, about Trump, or about Congress.  It is about us.  Let’s fight for what we need to keep us and our loved ones healthy and strong.