When President Barack Obama signed into law the healthcare reform bill Tuesday, he sealed his legacy and accomplished a goal that had eluded every president before him since 1945, when Franklin D. Roosevelt took a first stab at trying to provide healthcare for all Americans.
But it almost didn’t happen.
At the start of 2010, following a year of harsh, partisan debate, Obama’s quest for healthcare reform was still very elusive. To make matters worse, a majority of voters were against the plan, and Obama and the Democratic leadership in Congress had lost control of the message.
So, as he did during his presidential campaign, Obama rolled up his sleeves and hit the trail to make his case to the public that healthcare reform is both a moral and an economic imperative.
His strategy worked. On Sunday, March 21, the U.S. House of Representatives took an historic step and passed a reform package with a vote of 219 to 212. Obama can now take his place beside other presidents who changed America, such as Roosevelt, who crafted the New Deal, and Lyndon Johnson, who heralded the Civil Rights Act in 1964 and Medicare in 1965.
“I think it would have been very damaging if the bill hadn’t passed, but I don’t think it will be a factor in the midterm [elections],†said San Francisco State University political scientist Robert Smith, who believes that by then, most Americans still won’t understand what’s in the reform package. “But the fact that he got the bill done is an accomplishment, and most Americans like winners,†added Smith.
Already, Republicans are pledging to win back control of Congress on the steam of the bill and to repeal it. Several states, including Texas, Florida, and Virginia, are planning to challenge the constitutionality of the bill.
Republican National Committee Chairman Michael Steele criticized the measure Sunday in his blog, saying that “the bill will cause 9 million people to lose the insurance they have now, it will increase the deficit by over a $100 billion when all the components (including the physician fee schedule change) are included, it will increase taxes by $569 billion, it will cut Medicare by $524 billion.â€
How the public will ultimately judge lawmakers remains to be seen. Now that the thorny legislative process is over, Democrats must do a credible job of persuading voters that they’ve done the right thing. They say they are confident that once voters begin to feel the immediate benefits of their plan, they will be fully on board.
Coverage will be extended to approximately 31 million people who are currently uninsured. Insurance companies will no longer be able to withhold coverage based on pre-existing conditions. Children will be allowed to remain on their parents’ plans until they are 26 years old.
“The bill is going to transform healthcare for every American positively, but especially for African Americans. In my district alone, which is a majority black district, we have over 100,000 citizens who have no health insurance whatsoever,†explained Rep. G.K. Butterfield (D-North Carolina). “And once this legislation is fully phased in, most, if not all of them, will have quality healthcare, the same quality healthcare that I have as a member of Congress. That is transformational.â€
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Transcript: Obama’s remarks at signing of healthcare bill
According to Cara James, director of race, ethnicity, and healthcare at the Kaiser Family Foundation, the bill’s expansion of coverage and Medicaid eligibility will have major implications for African Americans who are uninsured by a margin of 1 in 5, compared to whites whose margin of uninsured is 1 in 10. She added that a greater focus on preventive care and cultural competency in providing that care, increased funding for community health centers, and efforts to increase the number of providers that include special student loan repayment plans will be hugely beneficial to minority communities.
Butterfield noted that the Medicaid expansion is a critical reform that’s been overlooked in the debate. “Right now, low-income families qualify, but not individuals. So the cousin or nephew who’s 31 and single and makes minimum wage and has no health insurance will be able to qualify. That is significant,†he said.
James also believes that the employer mandate will play a big role in expanding coverage to blacks because they tend to work for smaller companies where they earn lower wages and have less access to coverage because it is often too costly for their employers to provide it.
Small businesses with 50 employees or fewer will not be mandated to offer coverage. But those with 51 employers or more will, and they’ll be assessed a $2,000 penalty per employee if they don’t. However, the first 30 employees will be exempted from that penalty.
“Hopefully a company with 51 employees or more will have the
margin in order to provide insurance. They’re going to have to anticipate this,†said Butterfield. “[The bill will not be] fully operational until 2014. So smart business people can get ready right now to anticipate this.â€Later this week, Obama will travel to Iowa to continue making the argument for healthcare reform. And, says Rep. Elijah Cummings (D-Maryland), the president would be very wise to continue making such trips.
Like many of his colleagues, Cummings was saddened by the bitterness of the road to reform, which included incidents last weekend of Tea Party members and other protesters spitting and hurling racial epitaphs at black lawmakers, including civil rights icon Rep. John Lewis (D-Georgia).
To Cummings’ dismay, even after those incidents, Republican lawmakers went out on a balcony overlooking the protesters holding signs that read “Kill the bill.â€
“It seems to me that there’d be a level of sensitivity where they’d say maybe we need to tell these folks to chill out, that this is the last thing we should be doing,†said Cummings. “That’s why Obama has to continue to ride the horse that brought him [to office], because when he gets off and lets anything else get in between, he loses the power that the people gave him.â€
For now, with this win under his belt, Obama has essentially reestablished his presidency, said Larry Berman, a University of California-Davis political scientist.
“Here’s a new president who, after 13 months, didn’t let the system defeat him and has this major legislative accomplishment. Rather than restarting or recalibrating, in many ways it establishes his presidency in historic terms and also gives him momentum,†he said. “Obama can now move forward. There’s no reason he can’t tackle other issues.â€
But like Cummings, Berman believes the president must become more of a “communicator-in-chief†and use the bully pulpit to explain the historic significance of the legislation and how it will provide insurance coverage for all Americans.
Smith said Obama must now turn his attention to financial reform and apply the same level of tenacity he did to healthcare reform. “The House has passed a pretty good bill that puts in place regulations to prevent the things that brought about the near collapse of the economy. Obama has to fight for as strong a bill as possible, otherwise there will be a repeat of the economic crisis in 10 years.â€
Berman agrees. Success for both Obama and Congressional Democrats will depend on how successfully the economy rebounds: “He’s got to get jobs for Americans, and that’s how he wins independents back. If jobless numbers go down, that helps him in crucial key states. But if he doesn’t turn around the economy, whatever happens with this bill, it will be disastrous for him.â€
Still, he adds, for Obama, healthcare reform passage will likely all have been worth it. “He believes in it,†says Berman, who thinks Obama would rather be a one-term president who didn’t compromise his principles. “He’s no different from George W. Bush when it came to foreign affairs, doing what he thinks is right, no matter the consequences.â€
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