The effort to repeal and replace the Affordable Care Act , commonly known as Obamacare, is like a game of hot potato right now. First, the House quickly pushed through a health care reform bill with the assumption that the Senate would tackle any flaws. Now, the Senate is trying to pass something —anything—that can be taken to conference with the House.

In an effort to get a better understanding of some of the politics and perspectives around health care in the United States, we reached out to two organizational leaders from opposite sides of the issue to find out why they're for or against a repeal of the Affordable Care Act.

Sister Simone Campbell is the executive director of the Catholic social justice organization NETWORK. She advocated for the initial passage of the Affordable Care Act in 2010, and on Monday, delivered copies of a letter signed by more than 7,000 American nuns to members of the Senate, asking them to vote against any health care reform bill that would cut Medicaid.


"For us," Campbell tells VICE Impact, "the key factor is that so many people have access to health care who didn't used to have access to health care before the ACA, and this is a good step forward. People cannot afford insurance on their own."

Campbell says the expansion of Medicaid led to low-income workers being able to access health coverage. To illustrate how that access ultimately leads to better health outcomes, she recounts meeting a low-wage worker in Arizona named Maria who was able to get insurance because of the ACA.

"In getting established with a doctor, they found out she has cancer, ovarian cancer," Campbell says. "And because of that, she was able to get treatment. She's a contributing member of society, she's caring for her grandkids, she's doing well. They want to take that away from Maria and other people like her. We say that's wrong."

The foundation of Campbell's opposition to a repeal of the ACA is based in her faith. She says, "The church teaches [that health care] is a right and not a privilege for the wealthy; it's our basic tenet about the dignity of all human beings. In order to live in dignity, in our world, requires having access to quality affordable health care. And our church teaches that it's the role of good government to support what is needed for people to be able to live in dignity. It's just that it costs money and people think we shouldn't pay for what the common good requires."

"The fight is really about taxes and money," Campbell continues. "The fight is really not about health care. They just don't like paying for it, which I find shocking in the richest nation on Earth, that we can't care for the common good. Paul Ryan said, when he started this, he said, 'Well you know, well people shouldn't have to pay for sick people.' Excuse me, this is the whole point of insurance. There's a big pool of people where we pay for each other, knowing that at some point I'll most likely use health care. So I'm really grateful for your contribution to my health care down the road and in the meantime I'm willing to pay for yours. That's insurance. But somewhere that got lost in this conversation."

On the opposite side of the spectrum is Hadley Heath Manning, the policy director at Independent Women's Forum. She says the ACA had good intentions, but turned out to harm many people.

"Millions of people had quality insurance plans that were cancelled because they were not compliant," she told VICE Impact. "Premiums have skyrocketed, more than doubling since 2014. Medicaid rolls have become overburdened, making it harder for those patients to access care from the relatively low number of providers who will see them. The premise of the ACA was that everyone should have the same insurance and pay about the same for it, but this destroys market competition, the force we need to put consumers in control and hold down premium prices. Americans have a variety of needs and preferences for health insurance; we need health reform so that they can have greater choice in insurance plans, including choices for those with expensive medical conditions."

"One important metric of quality is access," she says, "and one way to measure access is through provider networks. The ACA has accelerated a trend toward 'narrow network' plans, meaning plans that are tied to fewer doctors and hospitals. Medicaid is very bad in this regard, because far fewer doctors will see new Medicaid patients compared to patients with private insurance. As we work together to ensure that more Americans can afford and obtain insurance coverage, we should also pay close attention to the value of that insurance coverage. Is it something they can use when they need to use it? Otherwise it's an empty promise. That's what the ACA has been to many people."

Last night, Republican Senators John McCain, Lisa Murkowski, and Susan Collins effectively ended the Senate GOP's push for health care reform for a "skinny repeal" that eliminates individual and some employer mandates but does not address high premiums. Previously, Republican senators failed to get anywhere on the Better Care and Reconciliation Act; it was voted down by nine Republicans and all 48 Democrats. Only time will tell how the next approach to health care pans out.