I’ve come out twice in my life: once as a lesbian, and then later as a cancer survivor. These tribes have something in common—we scare people. Even in these evolved times, we make them nervous. People don’t want to know us, they just don’t want us to be contagious. So coming out of the closet can still offer a little activist thrill. But it’s been a long time since it felt dangerous.

Now Mike Pence and Paul Ryan are bringing the danger back, threatening our LGBT civil rights and gutting the provisions of Obamacare that made it okay for us cancer recidivists to come out and be seen. And here we are, millions of us, sitting ducks, out in the open. Even if we wanted to hide, there’s not a closet big enough to hold us. What happens next?

I did my time in the cancer closet back in 2005. I hid the truth from my employers for a year and a half while the numbers climbed on my tumor marker tests. I felt sure that if they found out, they’d find a reason to let me go. I knew I had to protect my insurance, because this was my second go-round in four years. My cancer was a pre-existing condition.

I don’t know what will happen to my medical coverage if Obamacare is repealed. But I’m scared, and so is every cancer survivor I know. If you believe healthcare must turn a profit like any other business, then cancer is the obvious place to start cutting.

There are 14.5 million cancer survivors in America. We could populate a country the size of Zimbabwe. And boy, can we burn through money. My own treatment through three bouts of ovarian cancer cost well north of $1 million. What’s the cost to treat us all? According to an estimate by the National Cancer Institute, it’s more than $150 billion a year and climbing.

Come on, how many people are worth that kind of investment? Whatever happened to survival of the fittest? Thinning the herd? Republicans don’t say that, but you can hear Ayn Rand whispering in their ears.

Watch Paul Ryan trot out his Big Republican Ideas for statewide high-risk pools to a cancer survivor on a CNN town hall. See the concern on Ryan’s face. The budget he proposes wouldn’t cover a fraction of what we need—it’s a wonder he can mouth the numbers with a straight face—but set that aside. What really bugs Ryan about Obamacare isn’t the cost. He’s about to make everything cost more. What offends him is the idea that we all deserve coverage. Healthcare is supposed to be for those who earn it. The makers, not the takers.

Before Obamacare, cancer was the worst illness we could get as working people, because it made us so look so weak for so long. It wasn’t enough to fight the illness; we had to make an extra gushy show of devotion to our jobs so we could protect our insurance. So in response we did cancer the American way: We took on too much, came back to work too soon, and pretended it was no worse than a case of the flu. Most of all, we tried to keep our cancer story private. We knew our medical records would come back to bite us.

Then came Obamacare, and just like that, we could all exhale. For me, the cancer coming-out felt just as sweet as the queer one. I’m not going to say it was a pleasure when my cancer recurred for a third time in 2009. But at least I didn’t have to hide it. Never again, I thought.

Barack Obama watched his mother battle insurers as she died of ovarian cancer. He didn’t just let that slide. He managed to change things for hundreds of millions of Americans, including ovarian cancer patients like me.

I love you for that, Mr. President.

Contrast to that the unctuous Ryan, who says he’s budgeted $25 billion over ten years to fund his high-risk pools—covering cancer, diabetes, Alzheimer’s, the whole shebang. Ryan can’t be serious about that number. It’s too small. So what’s he really telling us? There should be scarcity. There should be fear. Reject the takers, reward the makers. America!

Ryan wouldn’t be able to dog-whistle like this if, on some level, “civilians” didn’t secretly look down on cancer patients. For us in the LGBT community, this contempt is an old story—especially those of us with HIV. Our tribes face such expensive challenges that, consciously or not, people want to believe we got sick because we did bad things. If they don’t have to feel kin to us, they don’t have to feel selfish about lowballing our care.

I can see that my two tribes keep getting attacked for the same old reasons. Is there anything we can learn from this? Then I remember a different Republican takeover, and I have an idea: What if we ACT UP?

Fourteen and a half million cancer survivors is an army. What if for just one day, we cancer vets stop being all grateful and polite and get royally pissed off instead? What if we show up in Washington, D.C.—all the bald heads and the wheelchairs and the ports and the drips? What if we storm Mitch McConnell’s office and ask how it feels to live through polio and then grow up to deny care for other people? What if we send Paul Ryan a stripper in a Speedo to say, I got your Individual Mandate right here?

When we talked about battling cancer, I never thought we’d mean battling Congress. But you know what? We outnumber them, and we’re tougher than they are.

We’ve been already been through chemo. What’s a few Republicans?

What You Can Do

* Tell your representatives in the House and Senate that if they want your vote, they have to stop this repeal.

* Come out of your cancer closet by visiting ACA Works. They're collecting stories from people who have benefited from Obamacare.

* Learn why the ACA is so important, find out what your options are, and sign President Obama's petition at Organizing for Action.