The Affordable Care Act of 2010, better known by its commonly used name Obamacare is perhaps the most controversial and talked-about law to be passed and signed in a generation. That is understandable considering that spending on healthcare represents 16% of the American economy and every American needs healthcare at various times in their lives.
For the Democratic Party, the passage of the Affordable Care Act was a long sought after accomplishment. Since the administration of Woodrow Wilson during the Progressive Era of the early 20th century, the Democratic Party has believed that the government should play a large role in providing access to affordable health care to all Americans. Accomplishing this proved very difficult since a large portion of the American electorate has always been reluctant to allow the federal government to take a greater role in their lives. For the Democratic Party, progress towards the goal of having affordable healthcare for all Americans was slow, came in fits and starts, and only happened during times when Democrats held the White House and large majorities in Congress.
The Great Depression provided the Democrats with the first opportunity to begin down the road to universal healthcare access. With economic conditions in the country so dire in 1932, Franklin Roosevelt was swept into the White House and with him came overwhelming Democratic majorities in the House and Senate. Over the next several years, Democrats extended the power of government through the New Deal programs including Social Security and unemployment insurance. Although access to health care was not addressed, Democrats were able to convince more Americans that the government could play an active role in their lives in a positive way. Today, Social Security is a very popular government program and is often referred to as the “third rail” of American politics because politicians who try to touch it die at the ballot box.
The next time Democrats had enough power to attempt health care reform would not be until decades after the Great Depression and ironically it would be the actions of Democratic constituencies that would create the health insurance system that would be the target of future Democratic lawmakers. During the post-war years of the 1950s, labor unions took advantage of the post-war prosperity to demand greater benefits from corporations and one of those benefits was health insurance provided by employers. It was during this time that the system of obtaining your medical insurance from your employer became entrenched in American life. For the Democrats, the problem was that not everyone worked for companies that provided insurance – leaving millions uninsured.
By the mid 1960s, Democrats again found themselves with a President and overwhelming majorities in Congress. After the assassination of John F. Kennedy and with a weak opponent in Barry Goldwater, Lyndon Johnson won a landslide victory in 1964 and the first major government program to extend healthcare to a group of Americans was passed when Medicare and Medicaid became the law of the land.
Throughout the 1970s attempts were made to use government action to extend affordable health care access to all Americans, but those attempts met with failure. The election of Ronald Reagan and the era of conservative, limited government mentality that he brought to America meant that there would be no attempts at extending government’s role in the 1980s.
With the election of Bill Clinton and Democratic majorities in the House and Senate, Democrats tried again in 1993 and 1994. First Lady Hillary Clinton took the lead in drafted a comprehensive healthcare reform bill, but many, including representatives from the insurance industry and almost all republicans felt it went too far in inserting the federal government into people’s lives, and even many Democrats from conservative areas of the country could not support the First Lady’s efforts. “Hillarycare” as it was dubbed went down to defeat in the late summer of 1994 and just a few months later Republicans, campaigning in large part on the Clinton’s attempt to overhaul the healthcare system, rode a wave of discontent and took control of both the Senate and the House. Republicans held both one or both houses of Congress until January 2007, and with George W. Bush in the White House until January 2009, any meaningful government initiated healthcare reform was impossible, leaving Democrats frustrated and from their perspective more and more Americans either without access to quality care or struggling under the impact of ever increasing healthcare costs.
In 2008, history once again moved in Democrats’ favor. Eight years of a Republican in the White House set the stage for the American people to follow the historic pattern of giving the opposing party, the Democrats, the keys to the White House. The strain caused by the two Middle East wars and the burden of George W. Bush’s unpopular policies also left Republicans demoralized. Added to these was the frightening financial collapse of October 2008. This perfect storm of circumstances converged to give the Democrats their biggest electoral victory since 1964 and Barack Obama entered the White House in January 2009 with a mandate to get things done and with overwhelming Democratic majorities in both the House and Senate, including the holy grail of 60 Senators preventing the Republicans from filibustering any Obama initiative.
Barack Obama and his Democratic allies in Congress quickly moved to initiate their latest round of healthcare reform and addressed the issues they felt most important. The new bill, quickly dubbed Obamacare by opponents, would ensure that no American was denied insurance coverage due to pre-existing conditions. It allowed young people up to the age of 27 to remain on their parent’s insurance policies. At the same time it would set up state insurance exchanges to enable those out of work or struggling to buy insurance to get affordable policies through government subsidies while the poor or indigent would be able to enter the Medicaid system. To pay for it all, every American would be required to purchase insurance either through their employer or on their own. This individual mandate would become the most controversial aspect of the new law.
Even with complete control of the levers of government in Washington, President Obama and his allies didn’t have an easy time passing the Affordable Care Act. First, President Obama believed that bipartisan compromise was best and that a law passed only with Democratic votes would not be fully accepted by the American public. Because of this he spent most of 2009 reaching out to Republican Senators to try to get a few of the more moderate members of the GOP to support the law. He also had a few Democratic Senators from conservative states who were reluctant to go too far toward a government solution. Soon, the healthcare overhaul became bogged down in the Washington political process, leaving time for groups who thought the law went too far and those who didn’t think it went far enough to mobilize.
Far-right conservatives, worried about the repercussions of government interference in the healthcare market, founded the Tea Party Movement. At the same time, those on the far left pushed in the opposite direction advocating single-payer system where the government would provide access to health care to everyone.
Finally, with opposition growing and with the 2010 midterm elections looming, President Obama and the Democrats moved to pass the law. Even with an overwhelming majority in the House, Speaker Nancy Pelosi had a difficult time lining up enough votes, but eventually convinced enough of her caucus to support the law which was passed. Soon thereafter, Majority leader Harry Reid kept the Senate in session right up until Christmas Eve and after many tense negotiations was able to pass a Senate version.
Since each version was different, the two versions would have to be reconciled and passed again by both houses. Complicating this process was the special Senate election in Massachusetts, necessary after the death of Ted Kennedy, a man who had dedicated his career to healthcare reform. In what is probably the most reliable Democratic state, the GOP was able to win with candidate Scott Brown. This caused Democrats to lose their 60 vote majority in the Senate throwing the entire reform into disarray.
Faced with this set of circumstances, many believed that the President would back off and abandon obamacare. It was not the case, however, as everyone in the Democratic Party believed they had come too far to renounce. As it was becoming clear that Democrats would lose more seats in the 2010 midterm elections, some feared that in case of retreat it wouldn’t have been possible to revisit the health care reform for perhaps a decade.
As consequence, the President moved forward and convinced the House to pass a package of changes that would match Senate’s version. After a long process of negotiations and fierce debates, the Senate passed such modifications through the reconciliation process – which requires only 51 votes. After 100 years, the Democratic party had passed a law that reformed the U.S. healthcare system and extended affordable healthcare access to all Americans.
Democrats and their allies were jubilant, but there was still substantial opposition to the new law. Soon after, both States and individuals challenged the new law. With unusual speed the case made its way through courts and the Supreme Court agreed to decide on the constitutionality of the law in spring of 2012 before the law can take full effect on January 1, 2014.
Regardless of the opposition encountered and the outcome of the Supreme Court case (which hasn’t settled yet), the Democratic Party claims to have accomplished something that makes life healthier for all Americans. For them, a war fought through decades was finally won.
The Author did a major in history at the University of Tennessee, holds both a Bachelor of Arts (with a major in history) and a Master of Business Administration (with a concentration in marketing) from UT.
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