By the time his ambitious health care law was introduced, dismantled, cursed, left for dead, revived, compromised, passed, and finally signed into law, the entire process was dominated by Barack Obama. This placed a heavy burden on the president.
His signature legislative achievement was the passage of the Affordable Care Act, which propelled the Republican Party to major midterm election victories and a majority in the House of Representatives. And Obama thought he might be the next person to pay the price at the polls. In late 2010, he told his aides: “The president’s term is becoming one term.”
He turned out to be wrong, but the fatalism Mr. Obama privately expressed that day captured the grave consequences of one of Washington’s most dangerous legislative battles in modern times.New set of oral histories released on fridayon the eve of its 14th anniversary on Saturday, chronicles the behind-the-scenes fight to transform the nation’s health care system to cover tens of millions of Americans without insurance.
Interviews with key figures from the drama were conducted by Insight, Columbia University’s social science research institute, as part of the second installment of a yearlong effort to document the eventful era under the 44th president. It was published. The recordings posted online Friday included recollections of 26 White House staffers, members of the Cabinet and Congress, as well as activists, interest group officials and a handful of Americans who spoke out. It did not include the president himself or his own recollections. What matters is his Republican opponents.
These oral histories cover Obama from a clueless candidate embarrassed by the platitudes he spewed on the campaign trail to a besieged president who staked his political future on high-stakes brinkmanship. It records his progress. They also saw Obama as a solid, highly disciplined, but not particularly mild-mannered policy geek who scrolled through the Brookings Institution website for ideas and had to overcome his own political mistakes. fleshed out his character.
In some ways, the story of the Affordable Care Act begins in 2007, when Mr. Obama was running against Sens. Hillary Clinton, John Edwards, and Joseph R. Biden Jr. for the Democratic presidential nomination. It began with a candidate forum on health care. “Senator Obama was terrible,” recalled Neera Tanden, who worked for Mrs. Clinton at the time. “He was dazed. He didn’t have any knowledge about this issue, so he kept saying, ‘That’s why we need to come together.'”
She said Obama knew he had done something wrong and that made him take the issue more seriously. “Honestly, if he hadn’t been in such a terrible situation, we wouldn’t have made such a detailed plan,” Tanden said.
After Ms. Clinton lost in 2008 and Ms. Tanden joined the Obama campaign, “a lot of his advisers were saying, ‘We should get rid of this health care,'” she said. He clearly said, “When I’m president, I’m going to work on health care.” You all have to figure out how to successfully run a campaign to establish our mission, and I’m doing it. ”
Mr. Obama, who took office in January 2009, has grappled with challenges that have bedeviled presidents of both parties, most recently President Bill Clinton’s failure to pass a sweeping health care bill during his first term. His term of office was about to collapse. Mr. Obama’s advisers were determined to learn from his past mistakes.
The Obama administration could simply do what the Clintons did in the 1990s by developing its own plan in public and involving key stakeholders with a stake in the issue, such as insurance companies and the president of Congress. He hoped to not only submit the plan he had developed in secret to Congress, but also gain support for it.
“The Clinton administration was focused inward on policy perfection, and I was a part of that, so I don’t want people to think that’s ‘out of this world,'” said Trump, a Clinton administration veteran. said Nancy Ann DePerle, who has been appointed director of . Obama administration’s White House Office of Health Care Reform. “The Obama administration was the opposite. It was more focused on stakeholders and the public, and more focused on letting Congress do its job of debating policy and passing legislation.”
But Mr. Obama himself made the wrong decision. Mr. Tanden, who became a senior adviser at the Department of Health and Human Services, praised Mr. Obama’s determination to pass sweeping reforms, but his team still spent “an inordinate amount of time” on small issues rather than systemic ones. He said he had spent a lot of time and had no results. Initially, he expected abortion to be a “big issue.”
Ezekiel J. Emanuel, the special assistant for health care, similarly praised Mr. Obama, saying he “never wavered,” and said the White House should send members of Congress home for the 2009 summer vacation, and that the plan was to do so. He said that he should have prepared slide materials to explain the matter. Component. “We didn’t do our job, and I think that was a big mistake,” Dr. Emmanuel recalls. “We needed a better tool to explain it to people.”
Peter R. Orszag, director of the Office of Management and Budget, experienced the misunderstanding and distortion of the plan while vacationing in Maine that summer. There he saw a sign in front of a store falsely warning about “death panels.” It will be created by law.
“This was probably the first time it really hit me,” he said. “You just see sign after sign about something and you understand why people think it’s a destination.”
After that, hopes of winning Republican support all but disappeared, leaving Mr. Obama to work only with Democrats. He was deeply involved in the haggling. Kathleen Sebelius, then Secretary of Health and Human Services, recalled a key meeting in January 2010 to reconcile various versions of the plan. “The president led the negotiations from beginning to end,” she said. “He was the negotiator.”
It will eventually pass, but not without painful concessions and legislative machinations. Ms. Sebelius spoke about the champagne celebration that took place that night on the Truman Balcony of the White House. Biden, her vice president at the time, told her, “This is the most important thing a president does for the international community.”
She asked what he meant. “When this young president says, ‘I’m going to do something,’ the world will know that he will do it,” Biden responded.
Still, Mr. Obama didn’t know how much time he would need to do anything more. Ms. DePerle was an aide who remembers Mr. Obama mulling over his one-term term while trying to convince him to stay in the White House beyond his health care.
“As long as I can get things done that I think are important, I’m fine with that,” he said of the possibility of a four-year presidency. However, DePerle found his comment “very surprising” and thought, “Oh, this is my fault.”
Ms. DePerle offered some of her most personal observations about the celibate president. Among other things, she said he refused to eat in public and ate only at set times each day. When he dined with his staff, “you ate with him in silence” while he sat and read a book or prepared for an upcoming event. And his meals were almost always the same: salmon or dry chicken breast, brown rice, and broccoli.
“Trust me,” she said. “That was it.” His only taste? “Give it some lemon juice or something.” And never dessert. “For him, food is like putting coins in a meter,” she said. He wouldn’t even eat pie, even though she said she liked pie. “He doesn’t have any weaknesses that I can tell you,” she said.
Mr. DePerle had always felt a sense of mystery about Mr. Obama, but it wasn’t until he accompanied him to his home state of Hawaii that he began to understand him. “Waves come in and go out,” she said. “His calm demeanor is like that to me, too. He doesn’t get too upset about anything. And the fact that he was as close to Tokyo as he is to New York, he has an international advantage. I have points,” she added. “He sees the world in a different way than many American presidents.”
Of course, at the end of the day, he had two terms left in office. And the Affordable Care Act, despite its birth pains and flaws and Republican efforts to repeal it, remains the law of the land.
