The fight over the Affordable Care Act grows more shrill each day. After more than 40 unsuccessful attempts to undo the ACA, House Republicans have succeeded in holding the government hostage in a shutdown they say will end only when “Obamacare” is defunded. Meanwhile Democrats are using pop stars, Bill Clinton, and community groups to push for enrollment in the newly created health care exchanges, and are holding firm on maintaining funding for the ACA in Congress.
No public policy issue in the last four decades has provoked such intense debate or acrimony as the ACA. To understand why this law has become such a political lightning rod, you have to look back at the long history of attempts to establish universal health care, and ahead to profound impact the ACA will have on electoral politics and political culture far into the future.
Since the late 1880s, America has been wrestling with putting in place some system to provide its citizens with affordable health care.
In 2010, President Obama achieved what had eluded chief executives for 100 years: universal healthcare. Since the late 1880s, America has been wrestling with putting in place some system to provide its citizens with affordable health care. Teddy Roosevelt was the first president to propose universal health care but politics caused him to drop it. FDR had universal health care in his original vision for Social Security, but politics came into play again, and he cut it out when it threatened the passage of the bill. Every president since — even Ronald Reagan — proposed universal health care only to have politics put an end to it.
President Obama learned from history. Many of his Democratic allies questioned whether he expended too much political capital to achieve the ACA. But, Obama knew that to make universal health care happen, he had to make it his highest priority, he had to do it early in his presidency, and he had to capitalize on the opportunity presented by the recession that threatened employer-based health coverage.
The resulting law goes further than past proposals by increasing access, improving quality, and reducing the cost of care all at once. As a result, the ACA will have a greater impact on more people than perhaps any law in American history.
Because of that, the ACA has become more than just a significant piece of public policy. It is the symbol of the role of government in the lives of the American people. As Kavita Pavel of the Brookings Institute incisively observes in the recently released book “The Affordable Care Act as a National Experiment,” “President Obama clearly signaled his commitment to health care reform as the linchpin of a social contract with the nation.”
By early next year, the bulk of Obamacare will be implemented. If, after a few years of its full implementation, the ACA is perceived as a success in the minds of the public and enshrines government’s role in providing access to health care, Democrats stand to reap the same windfall of political support they enjoyed in the wake of Social Security and Medicare/Medicaid in the 1960s.
If the ACA is viewed as a failure, caused by “big government” overreaching, Republicans will gain political dominance on policy issues for years to come by casting themselves as the party that worked hard to repeal this “mistake” from day one.
This shows the potential power the ACA has in “realigning” the future of politics and policy in America.
The ACA has become more than just a significant piece of public policy. It is <i>the</i> symbol of the role of government in the lives of the American people.
An example of the realignment of electoral politics can be seen in 1932 election of FDR, which is considered “realigning” in that it fundamentally shifted electoral coalitions for decades to come. And, surely the passage of Social Security in 1935 solidified that shift. The election of Ronald Regan provides an example of the realignment of political culture. While Republicans did not enjoy a stretch of electoral dominance, Reagan’s lasting impact is that he shifted the political debate to the right. What were once conservative ideas have been embraced by Democrats, such as welfare reform by Clinton in the 1990s. Even major planks of Obamacare itself emerged from conservative think tanks like the Heritage Foundation.
The stakes are so high around Obamacare because it has the potential to “realign” both electoral politics and political culture for decades to come.
Over the next several years, the Affordable Care Act will continue to evolve, mature, and be refined. While there will be glitches along the way, and the political rancor will continue, I believe the ACA will survive it all and be seen as a major advancement that solidifies government’s role in providing health care, and, like Social Security, seen as an essential part of the social contract to provide support and protections to the American people.
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This program aired on October 16, 2013. The audio for this program is not available.