President Barack Obama is applauded after signing the Affordable Care Act March 23, 2010, in the East Room of the White House.
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So many presidents tried it.
From Harry S. Truman to Richard Nixon to Bill Clinton. Some say as many as seven presidents attempted to pass some form of national health care with few results, often stymied by the notion that social welfare should be left up to the states.
But Barack Obama, in his first term as president, succeeded where so many had found failure, becoming the first president to pass a reformative plan for national health care, one that also confronted the practices of insurance companies that have historically disqualified from quality medical coverage millions of Americans, many with pre-existing health conditions or predisposition to them.
In this next installment of The Root’s series, His Lasting Legacy, we take a look at the Affordable Care Act, arguably Obama’s greatest demonstration of efficacy. It was signed in 2010 when the country was still staggering to its feet from the Great Recession that had consumed the previous 18 months and left some 6 percent of the job force unemployed and, essentially, uninsured.
Economically, President Obama inherited a hot, nightmarish mess. Still, he pressed the issue, making the Affordable Care Act, the ACA, Obamacare—whether you call it by its official name or critics’ pejorative of choice—his signature piece of legislation. Its historical impact is being lived out by 20 million people who now have health coverage which, according to the White House, is the highest number of insured Americans in history. More than 3 million black people and 4 million Latinos now have health coverage, a particular victory for communities who disproportionately succumb to diseases that can be prevented and controlled. Obamacare has given people, especially people of color, access to care where there previously was none.
While there have been other successes in the Obama administration: the legalization of same-sex marriage, restored relations with Cuba—the Affordable Care Act shines as a standout accomplishment.
“Despite its shortcomings—and it clearly has many because it’s built on an existing system that is problematic—it is a remarkable political achievement,” said Michael Gusmano, associate professor of health policy at Rutgers University and research scholar at the Hastings Center. “We’ve been trying to adopt some form of comprehensive health coverage since the Teddy Roosevelt administration and, with the notable exception of the adoption of Medicare and Medicaid in 1965, this is really the first major success.”
An Alignment of Ideal Circumstances
Timing played a major factor in the success of Obamacare. Built on national health care achievements that started with the introduction of Medicaid by Lyndon Johnson in 1965, there were several variables in play that made Obama’s platform more likely than that of many previous presidents: he had majority in both houses, with 60 votes—at least for a while—in the U.S. Senate. Democrats, who had learned from the failure of the Clinton attempt at health care reform introduced back in the 1990s, were deliberate about working cohesively. That helped set the mood to push Obamacare forward.
“It’s always about an alignment of time and circumstances, but I think even when his Congress was Democratic in both houses, which is a pretty good alignment for him for a short time, even when some of his top advisers said, ‘Don’t do this. Do the economy, do something else. Don’t get bogged down in something that can turn out to be disastrous for you the way the Clinton plan was,’ he said, ‘Nope. I’m doing it.’ He made a commitment to health care that people around him thought was foolhardy. He stuck with it and did it,” said Sandra Tanenbaum, professor of health services management and policy at Ohio State University.
Adding to that diligence, said Gusmano, was the president’s political skill and the amount of personal political capital.