Marketers for the Obama Legacy Network have been sending out e-mails calling attention to five favorite “moments and victories” in the Obama Administration in order to solicit new members and to raise funds. In an earlier post, I explained why four of these five moments weren’t so special after all, and also said that I would analyze the fifth, passing the Affordable Care Act (ACA) later since that evaluation is somewhat complex. This post will analyze the political cost of passing the ACA.
At the beginning of 2009 when health insurance reform was first taken up, the Democrats had huge majorities in both Houses of Congress. The President’s popularity was at its zenith.
He could have passed HR 676, the Conyers/Kucinich 35-page Medicare for All bill, producing true universal coverage had the President, Pelosi and Reid, been willing to back it and to use either budget reconciliation, or the nuclear option to get by the filibuster and eight blue dogs. They chose not to do that, but instead to let Congress work up a bill using regular order while attempting to achieve some bipartisan agreement.
The President for his part, enlisted Reid, Pelosi, and Montana’s Senator Max Baucus to de-rail any possible momentum in favor of a Medicare for All bill, and even, later, a bill with a strong public option, which, progressives had been persuaded, had a better chance of passing than enhanced Medicare for All. After the House deliberated for some months, Pelosi produced a bill with a weak public option in the middle of July of 2009.
But that bill was a sham. Even if it had passed all the way through Congress and been implemented as is, its public option enrollees would not have exceeded 10 million people according to CBOs projections, a figure far from large enough for the public option to have bent the cost curve of rising health insurance costs.
As it was however, by the time the bill went through multiple rounds of House and Senate transformations, partly in a vain search for bipartisan support, 8 more months had passed and the final bill, passed using reconciliation, cut out any public option and was essentially a high cost insurance company bailout accompanied by various goodies for people, but none that solved the problem of universal coverage or imposed limits on price increases from the private insurance companies.
All in all, the deliberative process yielded a bill over a year after the process began that was projected to cover 35 million of the 45 – 47 million estimated uninsured at the time. But that in the end failed to get a single one of the bipartisan votes that Democrats had struggled to secure and that Obama, Reid, and Pelosi seemed to set such store by.
Contrast this with the possibility that a top down approach relying on leadership and party discipline, had a good chance of passing HR 676 by the end of March 2009, with implementation perhaps 6 months later (judging from the rapidity of Lyndon Johnson’s implementation of Medicare in 1966). So that, by the time the ACA had passed, a popular Medicare for All bill might have been providing universal health care for everyone by 8 months before the 2010 election. In short, even that small part of the opportunity cost involved in passing the ACA was very high indeed.
There were other consequences of pursuing and passing the ACA however. First, also due to the time the bill took up during 2009 and early 2010, very little legislation other than the ACA could be passed through Congress, apart from the Credit Card Reform bill (CCR), passed in the Spring of 2009 and the Dodd-Frank FinReg bill in the Fall, both very inadequate in containing the corporations that had caused the Crash of 2008.
No second stimulus was forthcoming, no energy and environmental legislation was passed. No infrastructure or education legislation passed. There was nothing addressing climate change.
In short, there was nothing for the Democrats to run on in 2010, except the inadequate stimulus, CCR, and FinReg bills, and the ACA itself – a 2300 word bill that no one could understand, and that would not come into full effect until 2014, even though taxes were being levied “to pay for it” from 2010 on. In context, the effort to pass the ACA and the bill itself all seemed, even at the time, like a lengthy process of political malpractice at variance with the simple fact that 2/3 of all Americans wanted a Medicare for All bill, and that the easiest thing for the Democrats to do was simply to recognize that and give them what they had wanted for years..
Meanwhile, the effort to pass the ACA, coupled with the Administration’s failures to: quickly extricate the nation from the recession; recapture the bonuses paid to financial sector executives working in companies that were bailed out by the Federal Government; and finally, deliver justice to those top executives in financial firms who had been responsible for the crash and who were still benefiting from the ongoing mortgage frauds and Administration bail-outs, had, with the assistance of a notable rant from Rick Santelli, right wing talk radio hysteria, and much Koch money, resulted in the rise of the Tea Party, just in time for the Summer of 2009 protests against the emerging health care reform bill, and the climactic 2010 elections.
In those elections, the Democrats tried not to run on the ACA. But the Republicans, for their part, ran on it joyously. They attacked it comprehensively, distorting it where convenient and necessary to frighten, but very frequently just relying on the facts about its features themselves.
The result was a great sweep for the Republicans, fueled by the growing Tea Party, and the passivity of discouraged Democratic voters, who, seeing the lackluster performance of their party, just stayed home. It was a victory at every level of government.
When it was over, the Democrats had lost big in State and local government, were swept out of their majority in the House and had their Senate margin considerably reduced. A further consequence was the Republican gerrymander and as the years passed more and more aggressive voter suppression. Nor were the electoral consequences finished.
In 2012 the Democrats won the presidency, but the Republicans increased their margins in the House due to the gerrymander, and the influence of the Citizens United decision. Democrats did comparatively well in the Senate, retaining control in that election, even though they had more vulnerable seats in danger than Republicans. In 2014, however, the Democrats lost again, including in the Senate, and still more governships, as the ACA encountered more trouble during its rollout in the fall of 2014. And even during the election of 2016 the ACA was a factor, because by then news of rising insurance costs, accompanied by renewed Republican horror stories about the Act, obscured its partial successes.
Given the closeness of the presidential election, it is even likely that the ACA and Hillary Clinton’s defense of it as a good basis for further reform was a factor in delivering the presidency to Donald Trump. If one doubts this, then think for a minute about the counterfactual, namely an election where what she had to defend was an enhanced Medicare for All bill passed in 2009, or failing that, a compromise bill passed then, along lines of providing enhanced Medicare for All for those over 50 and under 25.
So, the political cost of the decision to pass the ACA rather than Medicare for All, when the Democrats had overwhelming majorities in 2009 – 2010, stretched over four elections and cost the Democrats successes on a whole range of needed progressive programs.
All this stemmed from their loss of the House, the gerrymander, and the constant burden of having to defend the ACA and its limited charms and mixed successes during alll the election campaigns from 2010 on. What a waste of opportunities for passing other progressive legislation! What a catastrophic political albatross it was!
So, the final issue is was it worth it? Were the positive results for health care of pursuing and passing the ACA worth the very high political cost of passing this program and implementing it?