As I travel across the state listening to Rhode Islanders during this campaign, I’m often asked which vote I’ve taken that I’m most proud of.  Eight years after I voted to pass the Affordable Care Act, my answer is still the same.

I’m proud of the Affordable Care Act because I believe that a family with a child facing a serious illness has enough to worry about without choosing between life-saving care and their mortgage payment.  I believe that a mother who has battled cancer and won should not become uninsurable because she now has a pre-existing condition. In the wealthiest country in the world, it’s an outrage that seniors would need to ration medication, against their doctor’s orders, because they can’t afford a refill.  I’m glad to say the Affordable Care Act made terrible stories like those rarer in Rhode Island and across America. It’s why I’m so dedicated to protecting these gains from persistent attack by President Trump and Republicans in Congress.

Rhode Island is one of seven states where fewer than 5 percent of people are uninsured.  We are down from almost 12 percent before the Affordable Care Act. While that’s a major improvement, we have to keep moving in the direction of better coverage for more people and lower health care costs.

For many people, Medicaid expansion under the Affordable Care Act gave them the coverage they needed to take advantage of addiction recovery programs.  The most significant piece of legislation Congress has passed on opioids is my bipartisan Comprehensive Addiction Recovery Act, written with Senator Portman of Ohio.  CARA provided new tools for health care providers to address this epidemic, with Medicaid support.

I led the fight to close the Medicare prescription drug "doughnut hole,” saving seniors $5.7 billion on their medications.  We need to take further steps to lower skyrocketing prescription drug prices, like by allowing Medicare to negotiate better prices, and by allowing pharmacies to import medications from places where they’re not marked up so much.  The Republican party has stood in the way of those reforms.

We can expand on the leadership of Rhode Island groups like Coastal Medical, which are using provisions in the Affordable Care Act to improve service to their patients while lowering the cost of care — in the case of Coastal, saving an average of over $550 per patient per year over five years — by keeping people healthier.  I am working with Republican colleagues to advance those improvements.

What we cannot afford to do is go backwards.  Twice, the Senate has had to save the Affordable Care Act from Republican efforts to repeal it.  Every single Democratic vote in the Senate mattered during those tense days, as well as the courageous votes from Senators Collins, McCain and Murkowski.  Republicans are still determined to repeal the ACA. Right now, they’re even in federal court trying to get the law’s protections for pre-existing conditions declared unconstitutional.  Earlier this month, Senate Republicans voted to defend President Trump’s rule allowing “junk” health insurance plans that give the illusion of coverage without even basic, essential health services like emergency room visits and maternity care.

Republican majority leader Mitch McConnell recently indicated that he’d like to make cuts to Medicare, Social Security, and Medicaid after the November elections.  He also said the Senate will take another run at repealing the Affordable Care Act if Republicans pick up enough seats, calling failed repeal attempts a “disappointment.”  I take him at his word.

Control of the Senate is a toss-up. That means the future of American health care depends on November. Every single vote on the Senate Floor could make the difference in protecting real health care for real Rhode Islanders from far-right ideology.  

One clear lesson from the battles of the last couple of years is that every voice matters.  The collective power of the hundreds of thousands of Americans who showed up, called their representatives, and sent letters beat back President Trump’s repeal attempts.  The progress we’ve made in Rhode Island is at stake, and as your senator I will do everything in my power to defend and expand on our success.

Sheldon Whitehouse, a U.S. Senator for Rhode Island, is seeking reelection this year.