Congress has been locked in debate over the last year about repealing the Affordable Care Act. There have been numerous controversies over the process used, as well as the outcome achieved. We will reflect on the changes and the rhetoric that has emerged around health and the government’s role in providing a safety net. How should elected representatives weigh the short-term and long-term health care needs of their constituents in these contexts? What were the roles that health care providers and patients played in the debate, and how could they have been more effective?