This article will explain and assess the partisanism and political strategies surrounding the legislative processes, debate, and the enactment of the Patient Protection and Affordable Care Act of 2010.
For more than one hundred years, health care has provided the fertile political ground on which to play on people’s fear of change (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). The reason that health care reform continuously rises to the top of the political agenda is that people genuinely care about health care no matter how often it goes down in flames (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). The seeds of the defeat of health reform in the past have been planted and cultivated in this fertile ground by opponents of reform motivated by money and ideology (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). They have understood, since the first debates around “compulsory health insurance” in the early 1900s, that they could defeat reform by frightening people about proposals for change (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). The history of reform explains the continuing struggle around the passage of the Patient Protection and Affordable Care Act (ACA) in March 2010.
This article will show that passing major health care reform is a process swamped with special interests, driven by big money, and resonating with widespread anxiety, often because it is difficult to explain (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). This article will conclude that health reform is complicated and requires total and unfaltering presidential commitment. Finally, the Obama Administration implemented a strategy that addressed the failures of the previous decade to bring about success.
Partisanism and Political Strategies Surrounding the PPACA
The health care reforms that President Obama signed into law in March 2010 were seventy-five years in the making (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). U.S. presidents have struggled to pass national health care reform; most failed due to the highly charged political landscape. Implementation poses exciting challenges for Democrats, Republicans, and the political process itself (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). Until Obama’s PPACA, only Lyndon Johnson managed to enact significant new health care programs, in the form of Medicare and Medicaid (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019).
Why Did Health Reformers Win This Time?
It was a long time coming when in 2010 the Obama administration and a Democratic Congress passed by a single vote in the Senate and by legislative sleight-of-hand in the House a historic reform of US health care, the Affordable Care Act (ACA) (Weissert & Weissert, 2019, p. 1). In 2009, President Obama made healthcare reform one of his priorities (Jerry W. Taylor, 2019). He sent the PPACA bill to Congress in the first six months of his administration. Obama urged speed at every opportunity, just like President Johnson (Jerry W. Taylor, 2019).
A painful political process followed. Bitter partisan divisiveness began with debates over the public health option, public misinformation became prevalent (e.g., allegations that “Obamacare” provided for “death panels”) and charges of socialized medicine filled the media. After much maneuvering and intrigue (rarely seen even in Washington), the PPACA gained the necessary House of Representatives approval on March 21, 2010. Obama signed the PPACA into law on March 23, 2010.
Learning From The Past. A fatal mistake by the Clinton administration was its long delay in getting a health reform bill to Congress (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). Negotiations on the overhaul did not begin in either chamber until Clinton’s second year when the focus was on midterm elections (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019).
Getting the reform through Congress required many compromises: The public option was dead on arrival, and there was no Medicare buy-in; there were weakened cost controls and more limited subsidies for buying private insurance. Even after all of the compromises, the plan passed without a single Republican vote.
Strategic Lesson One: An Acceptable Policy Approach. The model for this approach to national reform began in Massachusetts in 2006 (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). By 2008, reformers were committed to proposals designed to meet their central policy goals with minimal disruptions to the existing health care system (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). The central innovation in this strategy, where conservative and liberal policies were blended, was in the individual market.” (The Politics of Obamacare: Health Care, Money, and Ideology, 2019).
Strategic Lesson Two: Win or Neutralize Industry Opposition. The objective was to appeal to two audiences (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). “The first was the health care industry, aiming to win the support of major industry players and avoid the industry-financed opposition that killed the previous efforts. The second audience was the public, with reforms aimed at addressing people’s biggest fears while avoiding changes to the financing arrangements that provided health coverage to a majority of Americans. Arguably the most substantial decision that reformers made in 2009 was to work with, rather than against, health system stakeholders (“Long Time Coming: Why Health Reform Finally Passed | Health Affairs,” 2019).
Strategic Lesson Three: Let Congress Lead with Legislative Deals. The Clinton Administration had spent nine months developing its bill; the Obama Administration deferred to the considerable expertise among Democrats in Congress, as well as to their institutional pride (“Long Time Coming: Why Health Reform Finally Passed | Health Affairs,” 2019). By deferring to the congressional leadership, the White House avoided fanning intramural fights that would have delayed the legislation and offended many members of Congress (“Long Time Coming: Why Health Reform Finally Passed | Health Affairs,” 2019). Moreover, as Democrats had all agreed on the overall approach, both Houses wrote bills that were readily reconcilable (“Long Time Coming: Why Health Reform Finally Passed | Health Affairs,” 2019).
The president repeatedly set deadlines for Congress (“Presidents And Health Reform: From Franklin D. Roosevelt To Barack Obama | Health Affairs,” 2019). The Obama administration’s most noteworthy achievement was herding this legislation through Congress (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). Congressional Democrats seldom made their disputes with the administration public; hasty meetings at the White House cooled conflicts that erupted, before the next news cycle (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). The contrast with the Clinton administration could not be more visible. (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019).
Strategic Lesson Four: A Well-Organized and Funded Grassroots Campaign. In the past efforts at reform, supporters did not field a well-organized, a national campaign to demonstrate grassroots support for change to members of Congress. While the Democrats focused on the congressional negotiations, at times, they lost control of the public debate (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). Opposition to health reform typically came from well-oiled, deep-pocketed corporate lobbies (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). However, for the ACA, many of those corporate stakeholders were explicitly in favor of this health reform.
Starting in 2007, a coalition of many of the largest progressive organizations in the country, including unions, community organizing networks, netroots, think tanks, and constituency groups began to prepare for the passage of health reform, contingent on a Democrat winning the presidency in 2008 (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). HCAN’s effort bolstered Democratic champions in Congress and prevailed on a critical mass of conservative Democrats to support the legislation (The Politics of Obamacare: Health Care, Money, and Ideology, 2019).
Strategic Lesson Five: The President Needs To Move Fast and Keep Pushing. President Obama took a key lesson from Lyndon Johnson, who pushed hard for Medicare and Medicaid early in 1965, after his landslide victory the previous November (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). President Obama held a health care summit with congressional leaders and significant stakeholders in March of 2009, and by June, legislation started to move (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). Like Johnson, Obama that political capital evaporates quickly (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019).
Most importantly, three times between February 2009 and February 2010, President Obama insisted on going ahead when many of the top White House staff argued against pushing for comprehensive reform (The Politics of Obamacare: Health Care, Money, and Ideology, 2019). Obama insisted on pursuing his reform despite the present economic crisis, surging deficits, and calls to wait for a better time (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). When Scott Brown, a Republican, shocked Washington by winning Ted Kennedy’s Senate seat, explicitly promising to vote against the ACA, many Democrats were ready to back off a reform that appeared to have grown toxic (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). Instead, Obama charged ahead, advocating change with newfound clarity and strength (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). Obama took a considerable risk, as defeat might have wrecked his administration (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019).
Conclusion. Health reformers had an established record of losing (“Long Time Coming: Why Health Reform Finally Passed | Health Affairs,” 2019). There were many reasons to believe that they would fail again (“Long Time Coming: Why Health the Reform Finally Passed | Health Affairs,” 2019). A polarized political landscape, soaring budget deficits, court challenges, and myriad other obstacles stood in their way (“Long Time Coming: Why Health the Reform Finally Passed | Health Affairs,” 2019). Obama and the congressional Democrats defied the odds. Partisan disagreement, bitter congressional fights, grassroots campaigns, and political plotting have been persistent characteristics of all healthcare reform efforts (Jerry W. Taylor, 2019).
Passing major health care reform is a process swamped with special interests, powered by big money, and resonating with widespread anxiety, often because it is difficult to explain (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). Health reform is complicated and requires total and unfaltering presidential commitment. Congress is the most complex, exasperating, unwieldy legislative body in the modern world (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019).
One reason that reformers finally prevailed in 2010 is that many of them had lived through and learned the lessons of 1994 (“Long Time Coming: Why Health Reform Finally Passed | Health Affairs,” 2019). Advocates for reform outside of government, critical members of Congress and their staffs, and advisors to the Obama Administration implemented a strategy that addressed the failures of the previous decade (“Long Time Coming: Why the Health Reform Finally Passed | Health Affairs,” 2019).
Considering the gauntlet the PPACA reform had to run, a President must learn to manage Congress (“Presidents and Health Reform- From Roosevelt to Obama | Health Affairs,” 2019). Democrats won the 2009–10 health reform fight by successfully applying lessons learned from past failures, including the importance of neutralizing interest-group opposition (“Long Time Coming: Why the Health Reform Finally Passed | Health Affairs,” 2019). Health reform addresses issues that reach beyond health care policy (Jerry W. Taylor, 2019). Every effort to pass national health insurance becomes an argument about the character of our nation (Jerry W. Taylor, 2019). The most deeply divisive matters are immigration, welfare, the role of government, abortion, religion, mandatory coverage, and, inevitably, race all mixed into the health care discussion (Jerry W. Taylor, 2019).
A polarized political landscape, soaring budget deficits, court challenges, and myriad other obstacles remain (“Long Time Coming: Why Health the Reform Finally Passed | Health Affairs,” 2019). Just yesterday, a federal appeals court questioned whether Democratic states and the House of Representatives have the right to appeal a court ruling that declared all of Obamacare unconstitutional (Demko, 2019). The Appellate court raises a new threat to Obamacare.
References
- Demko, P. (2019). Appellate court raises a new threat to Obamacare. Retrieved from https://www.politico.com/story/2019/06/26/appellate-court-raises-new-threat-to-obamacare-3496516
- Jerry W. Taylor, B. (2019). A Brief History on Road to Healthcare Reform: From … Retrieved from https://www.beckershospitalreview.com/news-analysis/a-brief-history-on-the-road-
- Long Time Coming: Why Health the Reform Finally Passed | Health Affairs. (2019). Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2010.0447
- Presidents and Health Reform- From Franklin D. Roosevelt … (2019). Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2010.0420
- The Politics of Obamacare: Health Care, Money, and Ideology (2019). Retrieved from https://ir.lawnet.fordham.edu/cgi/viewcontent.cgi?article=4861&context=flr
- Weissert, W. G. & Weissert, C. S. (2019). Governing health: Politics of health policy (5th ed.). Baltimore, MD: Johns Hopkins University Press. ISBN- 9781421428949