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SALT LAKE CITY --The Affordable Care Act was born out of a perfect storm of political will and unsustainable increases in the cost of health care.
Advocates for health care reform have fought for nearly a century to make universal coverage a reality. During the Great Depression, President Franklin Roosevelt worked to institute various social policies to combat the challenges of the troubled economy. While health care was considered, it fell by the wayside and was seen as a threat to the success of the Social Security Act, which was passed in 1935.
In the 1940s, Roosevelt presented a medical bill of rights in which he asserted that all Americans had “the right to adequate medical care.” The Social Security Board went on to recommend that compulsory health insurance be included in the Social Security program but was unsuccessful. President Harry Truman nearly succeeded in bringing about health care reform, but claims that it was a threat to capitalism — and segregation — put an end to the effort.
In the 1960s, Medicaid and Medicare were passed under the leadership of President Lyndon Johnson, providing health insurance to certain individuals with economic difficulties.
The 1970s saw the emergence of Ted Kennedy, one of America’s greatest advocates for health care reform. Kennedy called health care reform the cause of his life and worked tenaciously towards that end for decades. He found a key ally in President Bill Clinton who also believed strongly in the cause. However, Clinton, like his predecessors, was unsuccessful in bringing about health care reform.
On March 22, 2010, President Barack Obama ushered in the era of American health care reform by signing the Patient Protection and Affordable Care Act. He referred to the moment as the fulfillment of "decades of trying, and nearly a year of sustained effort and debate."
In 2006, President George W. Bush oversaw the implementation of Medicare Part D, a program that provided prescription drug benefits to Medicare recipients. However, Bush adhered to a different philosophy of government than Clinton and declined to pursue any substantial attempts at universal reform.
The election of President Barack Obama in 2008 gave new hope to those who believed in health care reform.
Speculation about Obama’s initial candidacy first began after he exhilarated the Democratic National Convention during his 2004 keynote address. Still, expectations were minimal when he formally announced his campaign and toed the line against Democratic favorite Hillary Clinton. In a groundbreaking fundraising effort, Obama raised hundreds of millions of dollars and energized voters with his slogans of “Yes we can” and “Change we can believe in.” He went on to defeat Clinton in the Democratic primary and ultimately to rout John McCain in the general election.
When he took the Oath of Office in January 2009, he did so with an inordinate amount of political capital and a determination to make health care reform a reality.
The same year that Obama took office the Social Security Advisory Board issued a report titled, "The Unsustainable Cost of Health Care." Although health care costs were already rising at an alarming rate (approximately 2.5 percent more than Gross Domestic Product every year), the report warned, “Current projections indicate that health care costs will increase by more than 70 percent over the next 10 years and will continue thereafter to consume an increasingly greater portion of personal income.”
Things were already bad, but they were going to get worse — and fast.Not only were costs projected to rapidly increase at an unsustainable rate, but baby boomers were also beginning to reach retirement age and appeal to the federal government for health assistance through the Medicare and Medicaid programs.
The costs of health care to both individuals and the government were already burdensome and they were only projected to get worse. Something had to be done.
Enter Obama.
While the president began with a great deal of political capital to expend, nothing suggests that the Affordable Care Act would have come to fruition had it not been for the fact that Democrats also controlled both the House and the Senate.
The reality that health care reform had been unsuccessful for so long made the issue a hot potato. In fact, the president’s Chief of Staff Rahm Emanuel confesses, “I begged him not to do this.”
But Obama insisted, and Emanuel went to work along with House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid to do whatever was necessary to succeed where so many others had fallen short. With the failures of the Clinton administration still fresh in mind, Obama’s team put together the strategy that would ultimately lead to victory for advocates of health care reform: “Whatever Bill Clinton did, do the opposite.”
Although the Democrats faced fierce opposition from both Republicans and the health care industry, the Affordable Care Act was signed into law in March 2010.
That something needed to be done to curb the unsustainable costs of health care in the United States goes without saying. It was necessary — even critical — to find a solution.
Nevertheless, the debate continues as to whether or not the Affordable Care Act is the solution that our country needs, and it will be addressed later in this series.
The next article will deal with some of the mechanics of the current legislation. In particular, what is the difference between the Affordable Care Act and the associated regulations that have yet to be released by the Department of Health and Human Services — and when will the legislation go into effect?
This is the second in a series of nine articles addressing the topic of health care reform.
Kurt Manwaring is pursuing a graduate degree in public administration at the University of Utah. He is the owner of Manwaring Research & Consulting and maintains a personal blog at www.kurtsperspective.blogspot.com.
