Yesterday marked the 15th anniversary of the Affordable Care Act (ACA), the landmark health care law passed by Barack Obama in 2010, also known as Obamacare. This reform saved countless people’s lives and was a huge step in the right direction in trying to fix America’s fundamentally evil health care system that prior to Obamacare, refused to cover many folks for preexisting conditions like diabetes. The monstrosity of the market pre-ACA gave insurance companies the ability to reject coverage for as many as 50 to 129 million of non-elderly Americans. One study suggests that more than 26,000 Americans aged 25 to 64 died in 2006 because they did not have health insurance, more than twice as many people who were murdered that year. From 2000 to 2006, around 162,700 Americans died because they lacked health insurance, and this study estimates that 25 percent of people aged 25 to 64 were more likely to die if they went uncovered.
The Medicaid expansions in the ACA that Trump is now trying to eliminate saved at least 19,000 lives from 2014 to 2017, and it is estimated to reduce annual mortality rates for older Americans by 39 to 64 percent. If you grew up in a post-ACA world sympathetic to Luigi Mangione, it’s hard to believe that America’s health insurance could get much worse, but you have lived in the best conditions for getting people health insurance that this country has ever seen. It was so, so much worse before Obamacare than it is today.
But just because the ACA dramatically improved America’s astonishingly evil status quo on health insurance does not mean it was good politics, and its passage is at the root of disillusionment with Barack Obama’s presidency where he campaigned on a much different platform than how he governed. Simple question for the Obama defenders out there: is passing Heritage Foundation policy good or bad? Barack Obama seemed to think it was good, as he told Matt Lauer on NBC’s Today in 2010 while defending the ACA.
“When you actually look at the bill itself, it incorporates all sorts of Republican ideas. I mean a lot of commentators have said this is sort of similar to the bill that Mitt Romney, the Republican governor and now presidential candidate, passed in Massachusetts. A lot of the ideas in terms of the exchange, just being able to pool and improve the purchasing power of individuals in the insurance market, that originated from the Heritage Foundation.”
And this is where the split between progress and good policy emerges. That the Heritage Foundation created a reform that dramatically improved the lives of Americans speaks more to the depravity of the status quo than the efficacy of the solution. The ACA was not a carbon copy of the health care plan that Mitt Romney implemented in Massachusetts, but like Obama said, many aspects of his health care plan “originated” in Republican circles. That insurance companies and medical groups heavily lobbied for it and got Obama to back down on reforms he campaigned on is more proof of how Obama’s signature legislation is not exactly a triumph of liberal ideals. The ACA is yet another example of how when Democrats face real policy resistance, their instinct is to fold.
Obama did not campaign on the ACA. He wanted a public option in his proposed health care platform. Despite having the backing of powerful House Democrats like Nancy Pelosi on a public option, Obama’s White House backed off this fight due to the feckless intransigence of the Democratic Senate and their complete and total capture by special interests. A lot of the Obama apologists just stop here in retelling the history of this saga, simply saying “conservative Democrats wouldn’t allow good things to happen.”
While the dynamic of conservative Democrats not wanting good things to happen is undoubtedly true in any year this century or last, this line of thinking lets the most powerful Democrat alive off the hook. Obama won freaking Indiana for Mayor Pete’s sake. North Carolina turned blue in 2008 for just the second time in the last half-century. Among partisan Democrats there is a popular conception of Barack Obama as just another Black man in America being held back by this country’s racism, but that is an insult to the hard work he put in to become one of the most popular politicians in America’s history. He had more power to push his vision on the party than any Democrat has had since LBJ, and he didn’t use it. He campaigned on a populist revolution and gave us incremental technocratic governance in a time where voters demanded wide-scale change in the midst of societal collapse. His failure to deliver the change he promised led to the creation of the Obama-Obama-Trump voter, and while the ACA is a triumph of progress, it is a failure of politics.
The Democrats had 59 Senate seats and a similar majority in the House in 2009. They were given the largest mandate in a quarter century by the American public to fundamentally shift the system away from the corrupt status quo that led to the 2008 Great Financial Crisis. That Obama let Joe freaking Lieberman and company push him around is an indictment of the 44th president’s political skills in Washington. Joe Biden was famously annoyed by Obama’s aloofness and desire to stay in the White House to try to rule by fiat, and their presidencies are a contrast in style as much as anything else. Barack Obama was a once-in-a-lifetime candidate, but his lack of experience in Washington was very clearly a huge detriment to his agenda.
The ACA was bad politics. It was an abandonment of the ideals that Obama was elected on, and it was a preview of the Democratic Party’s fundamental inability to get out of its own way that has now culminated in the total collapse of any kind of popular support for this useless group of gerontocrats. If you’re mad at Chuck Schumer for constantly capitulating to Republicans, you should be mad at Obama for similar reasons. He had an historic opportunity that only comes along once every generation or so to completely reorient the status quo, and instead he hired Clintonites like Larry Summers and reinforced the status quo. There is a reason that Barack Obama is reportedly jealous of Joe Biden, and it’s because despite having more liberal beliefs than his Vice President, Obama knows that his presidency will be remembered as more conservative than Biden’s was before October 7th.
There are a lot of roots of the current failure of the Democratic Party, but the politics of the ACA is perhaps the best summary of all of them. Democrats fell ass backwards into an all-time great candidate after trying and failing to shove their preferred candidate down our throats, a lesson they failed to learn and repeated in 2016. The public coalesced around a Democratic president like no one since Lyndon Johnson, and the party had a generational opportunity to truly lead us into a new world. Obama’s failure to strong-arm the more conservative Democrats by tapping into his immense support that dwarfed theirs helped damn the Democrats to passing a law that even Obama still accepts is “a first step” fifteen years later.
Barack Obama achieved immense progress by passing the ACA and saving hundreds of thousands if not millions of people’s lives, but he failed at the politics of healthcare. He was elected in the midst of a generational crisis created by Republican governance, and letting Republicans literally write policy in his administration was a betrayal of the mandate he was sent to Washington to enact. There are a lot of roots of the current crisis of confidence the Democratic Party finds itself in, but the disillusionment with Obama’s presidency is central to all of them.
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