http://www.theatlantic.com/politics/archive/2015/07/the-real-story-of-obamacares-birth/397742/
The Real Story of Obamacare's Birth
One reason for the continued resistance to the Affordable Care Act is a badly distorted narrative of how it became law.
This is, of course, a huge victory for President Obama. But the passage, implementation, and ratification of Obamacare continue to be plagued by a widespread belief that it was tarnished by the way it was proposed and debated. A raft of reporters, commentators, and politicians argue that the president made a huge mistake in taking up healthcare at the beginning of his term, before building relationships of trust with Republicans, and then compounded that error by jamming it through quickly without any Republican input or efforts to find common ground.
In the aftermath of King v. Burwell, it is worth going back and recounting what actually happened leading up to the enactment of Obamacare, and reflect a little bit on what might, and what should, happen going forward.
Did Obama Leap Rashly to Consider Healthcare Instead of Focusing on Jobs or the Economy?
There is no doubt that the president made healthcare reform a top early priority. There was good reason for doing so; past experience, including that of the Clinton health-reform plan, showed that waiting to pass a major social-policy change, in the absence of a great crisis, is a fool’s errand. A president’s momentum, his public support, and the backing of his party peak early, and major social-policy change by definition shakes up the status quo, creating losers along with potential winners and an even larger number of those unsettled by change. The longer presidents wait, the greater the likelihood that their opposition will mobilize and exploit uneasy voters. And the closer midterm elections loom, the more nervousness builds among lawmakers from the president’s party.
So to accomplish a goal that had eluded a slew of previous presidents, it was necessary to start early. But it is also the case that the White House and Democrats in Congress did not lead with healthcare reform. They began, instead, with a series of actions aimed at the broken economy, including the auto bailout and the major stimulus package, which included a series of programs to help financially strapped Americans, and to get more back to work.
We know that congressional Republicans pursued a conscious strategy not to cooperate with Democrats on the stimulus, voting in unison in the House against it. Very early on, Dave Obey, then chairman of the House Appropriations Committee, asked his counterpart on the committee, Republican Jerry Lewis, to get his leaders and rank-and-file to provide Republican ideas to include, and non-starters to exclude, in a stimulus plan and was told that there were orders from “on high” not to cooperate. But despite that, the stimulus package was adopted over a Senate GOP filibuster before a healthcare reform effort moved into full bloom. Could the stimulus have done more to create jobs in the short term? Certainly—but in part to accommodate Senate Republicans like Charles Grassley, who nonetheless ended up voting against the bill, 40 percent of the stimulus package was tax cuts that mostly did little either to add jobs or stimulate the economy.
Baucus very deliberately started the talks with a template that was the core of the 1993-4 Republican plan, built around an individual mandate and exchanges with private insurers—much to the chagrin of many Democrats and liberals who wanted, if not a single-payer system, at least one with a public insurance option. Through the summer, the Gang of Six engaged in detailed discussions and negotiations to turn a template into a plan. But as the summer wore along, it became clear that something had changed; both Grassley and Enzi began to signal that participation in the talks—and their demands for changes in the evolving plan—would not translate into a bipartisan agreement.
What became clear before September, when the talks fell apart, is that Senate Republican Leader Mitch McConnell had warned both Grassley and Enzi that their futures in the Senate would be much dimmer if they moved toward a deal with the Democrats that would produce legislation to be signed by Barack Obama. They both listened to their leader. An early embrace by both of the framework turned to shrill anti-reform rhetoric by Grassley—talking, for example, about death panels that would kill grandma—and statements by Enzi that he was not going to sign on to a deal. The talks, nonetheless, continued into September, and the emerging plan was at least accepted in its first major test by the third Republican Gang member, Olympia Snowe (even if she later joined every one of her colleagues to vote against the plan on the floor of the Senate.)
Obama could have moved earlier to blow the whistle on the faux negotiations; he did not, as he held out hope that a plan that was fundamentally built on Republican ideas would still, in the end, garner at least some Republican support. He and Senate Democratic leaders held their fire even as Grassley and Enzi, in the negotiations, fought for some serious changes in a plan that neither would ever consider supporting in the end. If Obama had, as conventional wisdom holds, jammed health reform through at the earliest opportunity, there would have been votes in the Senate Finance Committee in June or July of 2009, as there were in the House. Instead, the votes came significantly later.
At the same time, the overheated rhetoric, reinforced by conservative talk radio, cable television, blogs, and social media, has created a visceral backlash. It has kept every Republican presidential candidate calling for “root and branch” repeal of every element of Obamacare, prevented many states from expanding insurance to millions of people who need it via Medicaid, and erased any hope for the foreseeable future of bipartisan efforts to revise or tweak the law to make it more effective.
Interestingly, even Obama has said that Obamacare was drawn from Romneycare, the Massachusetts plan championed by then-Governor Mitt Romney. But Romneycare was itself derived from the Chafee / Grassley / Durenberger / Hatch Republican alternative to the Clinton plan. The essence of Obamacare is a structure devised in 1993-94 by those Republican senators, then rejected and renounced in apocalyptic terms by Grassley and Hatch. (Durenberger, retired from the Senate and a genuine expert on health policy and reform, took a very different tack from outside the body.)
Thanks in part to the overheated rhetoric demonizing the plan, guerrilla efforts to undermine its implementation and disrupt the delivery of its services continue apace. Perhaps they will end as it becomes clear, in the aftermath of King v. Burwell, that the law in its fundamentals is not going away. It may help a bit if more Americans, including prominent commentators, stop repeating a false political narrative about the genesis of Obamacare.
About the Author
The Real Story of Obamacare's Birth
One reason for the continued resistance to the Affordable Care Act is a badly distorted narrative of how it became law.
- 6:03 AM ET
This is, of course, a huge victory for President Obama. But the passage, implementation, and ratification of Obamacare continue to be plagued by a widespread belief that it was tarnished by the way it was proposed and debated. A raft of reporters, commentators, and politicians argue that the president made a huge mistake in taking up healthcare at the beginning of his term, before building relationships of trust with Republicans, and then compounded that error by jamming it through quickly without any Republican input or efforts to find common ground.
In the aftermath of King v. Burwell, it is worth going back and recounting what actually happened leading up to the enactment of Obamacare, and reflect a little bit on what might, and what should, happen going forward.
Did Obama Leap Rashly to Consider Healthcare Instead of Focusing on Jobs or the Economy?
There is no doubt that the president made healthcare reform a top early priority. There was good reason for doing so; past experience, including that of the Clinton health-reform plan, showed that waiting to pass a major social-policy change, in the absence of a great crisis, is a fool’s errand. A president’s momentum, his public support, and the backing of his party peak early, and major social-policy change by definition shakes up the status quo, creating losers along with potential winners and an even larger number of those unsettled by change. The longer presidents wait, the greater the likelihood that their opposition will mobilize and exploit uneasy voters. And the closer midterm elections loom, the more nervousness builds among lawmakers from the president’s party.
So to accomplish a goal that had eluded a slew of previous presidents, it was necessary to start early. But it is also the case that the White House and Democrats in Congress did not lead with healthcare reform. They began, instead, with a series of actions aimed at the broken economy, including the auto bailout and the major stimulus package, which included a series of programs to help financially strapped Americans, and to get more back to work.
We know that congressional Republicans pursued a conscious strategy not to cooperate with Democrats on the stimulus, voting in unison in the House against it. Very early on, Dave Obey, then chairman of the House Appropriations Committee, asked his counterpart on the committee, Republican Jerry Lewis, to get his leaders and rank-and-file to provide Republican ideas to include, and non-starters to exclude, in a stimulus plan and was told that there were orders from “on high” not to cooperate. But despite that, the stimulus package was adopted over a Senate GOP filibuster before a healthcare reform effort moved into full bloom. Could the stimulus have done more to create jobs in the short term? Certainly—but in part to accommodate Senate Republicans like Charles Grassley, who nonetheless ended up voting against the bill, 40 percent of the stimulus package was tax cuts that mostly did little either to add jobs or stimulate the economy.
Baucus very deliberately started the talks with a template that was the core of the 1993-4 Republican plan, built around an individual mandate and exchanges with private insurers—much to the chagrin of many Democrats and liberals who wanted, if not a single-payer system, at least one with a public insurance option. Through the summer, the Gang of Six engaged in detailed discussions and negotiations to turn a template into a plan. But as the summer wore along, it became clear that something had changed; both Grassley and Enzi began to signal that participation in the talks—and their demands for changes in the evolving plan—would not translate into a bipartisan agreement.
What became clear before September, when the talks fell apart, is that Senate Republican Leader Mitch McConnell had warned both Grassley and Enzi that their futures in the Senate would be much dimmer if they moved toward a deal with the Democrats that would produce legislation to be signed by Barack Obama. They both listened to their leader. An early embrace by both of the framework turned to shrill anti-reform rhetoric by Grassley—talking, for example, about death panels that would kill grandma—and statements by Enzi that he was not going to sign on to a deal. The talks, nonetheless, continued into September, and the emerging plan was at least accepted in its first major test by the third Republican Gang member, Olympia Snowe (even if she later joined every one of her colleagues to vote against the plan on the floor of the Senate.)
Obama could have moved earlier to blow the whistle on the faux negotiations; he did not, as he held out hope that a plan that was fundamentally built on Republican ideas would still, in the end, garner at least some Republican support. He and Senate Democratic leaders held their fire even as Grassley and Enzi, in the negotiations, fought for some serious changes in a plan that neither would ever consider supporting in the end. If Obama had, as conventional wisdom holds, jammed health reform through at the earliest opportunity, there would have been votes in the Senate Finance Committee in June or July of 2009, as there were in the House. Instead, the votes came significantly later.
At the same time, the overheated rhetoric, reinforced by conservative talk radio, cable television, blogs, and social media, has created a visceral backlash. It has kept every Republican presidential candidate calling for “root and branch” repeal of every element of Obamacare, prevented many states from expanding insurance to millions of people who need it via Medicaid, and erased any hope for the foreseeable future of bipartisan efforts to revise or tweak the law to make it more effective.
Interestingly, even Obama has said that Obamacare was drawn from Romneycare, the Massachusetts plan championed by then-Governor Mitt Romney. But Romneycare was itself derived from the Chafee / Grassley / Durenberger / Hatch Republican alternative to the Clinton plan. The essence of Obamacare is a structure devised in 1993-94 by those Republican senators, then rejected and renounced in apocalyptic terms by Grassley and Hatch. (Durenberger, retired from the Senate and a genuine expert on health policy and reform, took a very different tack from outside the body.)
Thanks in part to the overheated rhetoric demonizing the plan, guerrilla efforts to undermine its implementation and disrupt the delivery of its services continue apace. Perhaps they will end as it becomes clear, in the aftermath of King v. Burwell, that the law in its fundamentals is not going away. It may help a bit if more Americans, including prominent commentators, stop repeating a false political narrative about the genesis of Obamacare.
About the Author
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Norm Ornstein is a contributing writer for The Atlantic, a contributing editor and columnist for National Journal, and a resident scholar at the American Enterprise Institute for Public Policy Research.
