Obamacare will be Obama’s second big takeaway
We tend to use shorthand to talk about our presidents. Lincoln saved the Union and freed the slaves. Kennedy committed us to the moon landing and built the Peace Corps. FDR ended the Depression, created Social Security and won World War II.
It’s hard to know in the middle of a presidency what will be remembered, and even then it may change. Right now, LBJ is getting a new look beyond Vietnam, to include civil rights, poverty and Medicare. Someday Nixon will move beyond Watergate, and negotiations with the USSR and China will have their due. Even poor Jimmy Carter may someday get some props for the Middle East peace agreement. Can’t hold out a lot of hope for George W. Bush, though, unless painting becomes a historical test of presidents.
In the moment, presidencies are so eventful, it’s hard to guess what will last. The killing of Osama bin Laden? Who talks about that anymore? More people talk about Monica Lewinsky, which sadly will loom large in remembering Bill Clinton, an otherwise very successful president.
It’s clear, though, that for Barack Obama, the Affordable Care Act (ACA) is going to be the second takeaway after the first African-American presidency. Not so many weeks ago, people were talking about the collapsed Obama presidency and his limited role in history. The ACA was on its last legs. That, however, may be about to change.
Historians will surely note how many turns there were, how many debatable choices and some mistakes, mostly preventable, this White House made before the turnaround. Making health care priority No. 1 in 2009 reduced the Obama administration’s ability to fight more aggressively for a larger economic stimulus, costing his party massive losses in 2010 and resulting in Congressional gridlock that deepened the economic recession. Letting a group of Senate centrists delay passage of the health care law until the summer of 2009 allowed the Tea Party to negatively define the law, an image that only now is being challenged as Obamacare’s implementation finally takes shape.
Of course, the utterly foreseeable catastrophe of the health care rollout in September completely squandered the Democratic gains that might have come from the government shutdown.
But through it all, the president held onto his path and has been rewarded with results that are simply stunning. His bet on a flawed, complicated half-loaf health care program that not only enraged his opponents but also demoralized many of his supporters may yet pay off in the long run. The new numbers of enrollees are concrete evidence that this has happened, and it is big both governmentally and politically. Nearly 10 million Americans have a crucial benefit they didn’t have before, yielding virtually unlimited personal stories for political debate.
If the law continues to expand its reach within the red states that have blocked Medicaid expansion, millions more will be added to the rolls of those with assured health care. It’s really remarkable that in most cases this law drives the cost of benefits lower rather than higher and that Democrats were not afraid of its anti-poverty elements. This will be the first broad working-class and lower-middle-class law that Democrats have implemented since the 1960s.
In fact, this is so big that, as in the past, previous presidencies will now be seen in a new light. When LBJ signed the Medicare Act in 1965, he went to the Truman Library in Independence, Mo., so that Harry S. Truman, who had tried and failed to win such a law, could witness the signing. As we continue to revise our understanding of LBJ’s presidency, his 1965 victory on Medicare will be amplified by the success of the ACA. And reminders of Republican opposition to Medicare are already making the rounds of the political world, to suggest to voters how history might be repeating itself.
It’s also remarkable that the long-cherished goal of widespread health coverage has taken a perhaps irreversible step at roughly the same moment that the Supreme Court decided to further open the floodgates for oligarchy in campaign spending, leading to claims that American democracy is dead. And even more oddly, the Supreme Court is also the one institution that could have stopped the ACA, and despite its right-leaning tendencies, it was the one, by a 5-4 majority, that allowed the law to survive — on Chief Justice John Roberts’ vote. Talk about dramatic stakes. I wonder if Roberts worried that the court’s conservative majority could not do to the ACA what an earlier court did to Roosevelt’s early New Deal without setting off a political war it could not win, and that might jeopardize its other goals.
The ACA is not out of the woods yet. In fact, the next obstacle in the long and winding story of the ACA is the potential for a Supreme Court decision to block subsidies for health care under the ACA in states that did not set up exchanges. If people already have insurance and subsidies, the court may be wary of taking them away. There may be a race against time to get those benefits locked in before the High Court rules.
If the ACA keeps going, much of Obama’s remaining time in office may focus not only on an economic agenda (minimum wage, equal pay and other measures) but also on working through the ramifications of the new health care law and fixing problems that arise. The impact of expanded health insurance is going to expand beyond health care. A new study for the Rand Corp. contends that the ACA will have the effect of lowering the cost of liability for auto insurance. Unbound from restrictions on pre-existing medical conditions, people may also feel freer to leave bad jobs and look for new ones, competition that may drive up wages and strengthen coalitions for a higher minimum wage. And the Medicaid expansion alone puts Democrats back on a path they have veered from since the days of Lyndon Johnson: directly helping low-income and lower middle-class Americans to survive and thrive.
In theory, Democrats would be more likely to get the active votes of working people who need things that they don’t have (a belief that animated much of the Romney camp’s explanation for his defeat). But it often doesn’t work that way. Being hopeless and overwhelmed can make the act of voting seem to be a waste of time.
Latinos, working-class voters, young people and unmarried women all are widely known to be stay-at-homes in off-year elections like 2014 — and then they get hammered in public policy, including the voter suppression laws aimed at keeping them away from the polls that passed after the 2010 Republican sweep.
For folks who are struggling, it’s more important to gain something worth protecting than to have to dream of getting it. As Obama is discovering with Latinos with regard to deportations, Democrats are foolish to think they will win votes by saying, “Look how hard we are trying to get you what we need, while those mean Republicans keep it away from you.”
A little security can do wonders. Having the ability to see the doctor without going bust may make enough of an impression to create a bit of that sense of “political efficacy.” What opponents of the ACA have called “dependency” on government is really something quite different — the creation of confident people who are more likely to play their role in the governance of American democracy.
Raphael J. Sonenshein is executive director of the Edmund G. “Pat” Brown Institute of Public Affairs at California State University, Los Angeles.