The Obama Legacy: The Affordable Care Act
How a controversial law made history in the fight for universal healthcare
By David Oks
The Progressive Teen Staff Writer
MARCH 23RD, 2010 WAS PERHAPS THE MOST IMPORTANT DAY OF PRESIDENT OBAMA’S TWO TERMS. On that day, he signed the Patient Protection and Affordable Care Act — in the characteristically blunt words of Vice President Joe Biden, “a big deal,” with a word inserted in the middle for emphasis. And indeed, the law, popularly known as “Obamacare,” was, in the history of American progressivism, a very big deal.
To understand the significance of the Affordable Care Act, it is useful to recall the history of American healthcare reform. The idea of a universal healthcare bill arose among members of the Progressive Party in 1912. The idea returned in 1944 when President Franklin Roosevelt made healthcare a part of his “Second Bill of Rights,” and again in 1945 when President Harry Truman promised universal healthcare. Two of Lyndon Johnson’s most important Great Society initiatives were Medicaid and Medicare, which promised healthcare to poorer and older Americans. Senator Ted Kennedy fought vigorously for universal healthcare, to no avail. For decades, ambitious healthcare reform has been a chief progressive goal, but, the creation of Medicare and Medicaid notwithstanding, it has largely been unaccomplished.
In 2008, when Obama won a convincing victory with healthcare reform as one of his signature political issues, the tide seemed to turn. The bill that was settled upon was transformative. It was the biggest healthcare expansion since the Great Society. It made healthcare fairer: it prevented insurance companies from rejecting insurance applicants because of their pre-existing conditions and allowed people to stay on their parents’ health insurance plan until they’re 26. Meanwhile, it expanded Medicaid significantly and offered federal subsidies for insurance plans, making it more accessible. But its most ambitious —and most controversial — provision was its “individual mandate,” which demanded that people at a certain income level buy insurance or pay a penalty.
The healthcare debate which took place over much of 2009 and 2010 was an epic and highly divisive moment in American politics. Conservatives attacked Obamacare with vitriol, likening it to a socialization of healthcare (when it was less aggressive than proposals from Roosevelt and Truman in the 1940s). The bill’s complexity and length at 906 pages made it the target of vicious falsehoods, with some claiming that it offered free healthcare to undocumented immigrants and created “death panels” for senior citizens. During an address to a joint session of Congress discussing healthcare reform from Obama, a Republican congressman shouted “you lie!”
Despite it all, Obama never lost his cool, a characteristic of the president that served him well during all of his two terms. He was loyal to his campaign promise to conduct healthcare negotiations with the C-SPAN cameras rolling. Political crisis after political crisis made the bill look increasingly difficult to pass; a particularly painful moment came when Kennedy, a mentor of Obama’s still serving in the Senate, died, and Massachusetts elected as his replacement a Republican. Democrats could no longer break a filibuster, forcing them to scale down their ambitions somewhat. Obama remained insistent on the need for ambitious reform, and despite many challenges, the bill eventually passed the House, 219–212, and the Senate, 60–39.
When Obama signed the Affordable Care Act into law, it became his central policy achievement. It was, in some ways, a moderate bill. It was based on the reform efforts of Massachusetts Governor Mitt Romney, and the individual mandate, the most aggressively-attacked part of the bill, originated as a Republican idea. But, compared to where the debate was, the Affordable Care Act was one of the most progressive bills of our time, a partial realization of the dream of Roosevelt, Truman, and Kennedy, an important step towards a cardinal progressive goal: universal healthcare.
The Affordable Care Act was not a single-payer universal healthcare plan, nor was it the public option that Obama favored on the campaign trail in 2008. But it was certainly one of the best laws that could have conceivably come out of so polarized a political environment. Its effects were astounding: the patient safety measures it put in place saved an estimated 87,000 lives. The percentage of Americans who lack health insurance is consistently falling because of the Affordable Care Act. An example: in 2013, before many of the law’s provisions took effect, 18% of people in Cuyahoga County, Ohio were uninsured. Three years later, that percentage had dropped to 5%. The Affordable Care Act led to the rate of uninsured citizens falling in every Congressional district in the country. The law even led to a $2.6 trillion decrease in projected health spending. The bill was, in sum, a massive success, a triumph that came in spite of the bill’s uncertain voyage through Congress and the acrimonious debate the arose during its negotiation.
President Obama’s legacy will always be controversial among progressives. To some, he was far too moderate, too unwilling to challenge the status quo. To others, Obama is a progressive hero, a monument of courage and determination amidst near-unprecedented opposition. The Affordable Care Act reflects that reality. Regardless, the bill did what it set out to do and was hugely successful in doing it, and is surely the most substantive and ambitious effort the government has made on healthcare in generations. The final judgement of history will be that the Affordable Care Act, no matter what its political future is, has been, like the Obama presidency, a success.
