The Ella Austin Community Center’s auditorium was packed Saturday afternoon, as a crowd of about 200 filled the seats and lined the walkways, sweating in anticipation of the town hall meeting centered around health care and the Affordable Care Act (ACA).

Because the air conditioning system in the auditorium was no match for the sweltering summer day and full house, Ella Austin CEO Anthony Hargrove asked the crowd to “bear with [him]” as the AC worked double-duty.

Bear with him they did. Audience members remained – paper fans providing relief from the heat– actively engaged for more than two-and-a-half hours, standing in line to ask local congressional representatives questions.

“This is how democracy works,” community activist Ashley Smith told the audience. “You are here to let your voices be heard, to ask questions, and to hear responses from the people you elected.”

The meeting was sponsored by TX21 Indivisible with support of other San Antonio area chapters. Indivisible is a national campaign that focuses on resistance to the Trump administration and its policies. U.S. Rep. Lloyd Doggett (D-San Antonio) and U.S. Rep. Joaquín Castro (D-San Antonio) were in attendance.

A crowd of about 200 people fills the Ella Austin Community Center auditorium at the healthcare town hall. Credit: Roseanna Garza/San Antonio Report

U.S. Rep. Lamar Smith (R-Texas) and U.S. Rep. Will Hurd (R-Texas) declined invitations to attend the town hall meeting.

“The worst thing we can do as Texans is to allow politics to divide us,” Castro told the audience. “We are at our best when working together.”

The ACA has been a point of contention between Republicans and Democrats since it was signed into law by President Barack Obama in March 2010. For seven years, Republicans have riled against the legislation, but have struggled to present an achievable alternative.

Roughly 20 million people have gained coverage through the ACA. Repealing the law was a top priority for President Donald Trump and Republicans in Congress, who say it has driven up premiums and forced consumers to buy insurance they do not want and cannot afford.

House Republicans narrowly passed a bill to repeal the ACA in May, a difficult-to-achieve vote that was supposed to set the stage for Senate action. But with conservatives and moderates so far apart in the Senate, Republicans struggled to bridge the gap between them, resulting in a legislative dead end.

Conservatives wanted to see the ACA completely eradicated, but moderates worried about the effects that would have on their most vulnerable citizens.

The failed Trump alternative(s) included key provisions allowing for the sale of low-cost, stripped-down health plans, which opponents have argued would increase premiums and undermine protections for people with pre-existing medical conditions.

Trump recently declared that his plan is to “let Obamacare fail,” and suggested that Democrats would then seek out Republicans to work together on a a healthcare bill to bury the ACA.

In what appears to be an effort to hasten the ACA’s demise, Trump’s administration has ended ACA contracts that brought assistance into neighborhoods in 18 cities, making it even more difficult to enroll the uninsured and help people already covered re-enroll or shop for a new policy.

While the contracts were temporary, they funded companies to hire “navigators” to spread the word in the community – at churches, libraries, and sporting events – and guide people through the often-complicated enrollment process.

San Antonio is one of the 18 cities affected by federal funding for enrollment assistance being pulled. Dallas, Houston, Austin, McAllen, and El Paso are the other cities in Texas affected by the elimination of these contracts.

In addition to the reduction in enrollment assistance, people will now have 45 days to shop for 2018 coverage, starting Nov. 1 and ending Dec. 15. In previous years, they had twice as much time.

Doggett told the Rivard Report that due to the dramatic cuts in funding for assisting local vulnerable populations enrolling in healthcare, “we have to make up for that at the local level.”

“Even with all of the effort that we have had in the last couple of years, there are too many families who are uninsured in the Bexar County area,” Doggett said. “Outreach, particularly to Latino families, was insufficient [before], and now it appears to be nonexistent.”

EnrollSA is a coalition of local government and healthcare officials that has made efforts to sign people up for ACA health insurance coverage in Bexar County since 2013. Castro said these organizations will have to “pick up the slack” to help support ACA enrollments.

U.S. Rep. Joaquín Castro (D-Texas) speaks to the audience at the healthcare town hall at the Ella Austin Community Center. Credit: Roseanna Garza / San Antonio Report

Castro told the Rivard Report that the “drastic cuts are endangering the ACA,” making it more difficult for people to understand their options for insurance and enroll in coverage.

In 2014, Texas ranked 49th in the nation, with only 47% of Texans enrolled in employment-based health insurance coverage. Texas’ rate of uninsured people fell to 16.8% in 2015 following the implementation of the ACA.

In 2010, the national rate of uninsured individuals was 16%. The Centers for Disease Control and Prevention (CDC) reported that in the first nine months of 2016, a mere 8.8% of Americans – or 28.2 million people – were uninsured. That’s a drop of 0.3 percentage points from the same period in 2015.

Texas still leads the nation in uninsured adults.

“I’m convinced that what stopped the healthcare repeal is people like you,” Doggett told the audience at the Ella Austin Community Center.

According to reports from the Trump administration, about 12.2 million people signed up for ACA plans during the 2017 enrollment period, falling short of the Obama administration’s projected signups of 13.8 million people. Enrollmen is slightly down from the 2016 enrollment period. Of those who signed up for plans for 2017, 31% were new customers.

Both Doggett and Castro agree that changes can be made to improve the current healthcare system.

When speaking about insurance plans, Castro said it is time for Democrats to get behind a single-payer healthcare system and doesn’t “believe [he] is alone in that thought.”

Doggett agreed, citing Medicaid alternatives he supported in the past, including Medicaid for More, which aimed at increasing availability and allowing people to buy in and later, Medicaid for All, a single-payer option.

“I support universal healthcare coverage,” Castro said. “How we get there is the debate. As you can imagine right now we are so far from that bill.”

While the town hall was set with the intention of covering topics related to healthcare, audience members had many other things on their minds. Doggett and Castro fielded questions regarding tax reform, the “sanctuary cities”  and “bathroom” bills, environmental protection, gerrymandering in Bexar County, medical marijuana, national security threats, and more.

In response to a question from a resident of congressional District 1 regarding medical marijuana, both representatives said they support reviewing current restrictions. Doggett cited a story about a close friend whose daughter suffers from epileptic seizures; he saw firsthand the positive benefits of medical marijuana, which is one reason he believes that “there ought to be other alternatives available.”

Speaking in response to questions about immigration, Castro told the audience that “the immigration system is broken,” and comprehensive reform is necessary. Doggett agreed, stating, “we have to find a way to get a fair and just immigration system in place.”

When asked by an audience member from congressional District 15 what they are doing to “stop the decimation of the Environmental Protection Agency,” both congressmen reported working hard to address what Doggett called “a major national security threat.”

Roseanna Garza reports on health and bioscience for the San Antonio Report.