In his eloquent, nearly one-hour long farewell speech to America Tuesday night, President Obama made just a passing reference to the Affordable Care Act, his signature health care program now under relentless attack by congressional Republicans and his successor, President-elect Donald Trump.
Speaking to a crowd of 20,000 adoring supporters at the McCormick Place convention center in his hometown of Chicago, Obama noted that the nation’s uninsured rate has “never, ever been lower,” health care costs are rising at the slowest rate in 50 years, and – for all its problems –Obamacare’s detractors have not yet been able to come up with a better idea as a replacement that can cover more than 20 million previously uninsured Americans.
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In what seemed like a challenge to Trump, Senate Majority Leader Mitch McConnell (R-KY) and House Speaker Paul Ryan (R-WI), Obama said that “If anyone can put together a plan that is demonstrably better than the improvements we’ve made to our health care system – that covers as many people at less cost – I will publicly support it.”
With just 10 days remaining before he relinquishes the White House, Obama sought to celebrate the achievements of his eight years in office while asserting the need for Americans to vigilantly guard their democratic rights and principles. The clear and present danger, he said, is for Americans to succumb to xenophobic fears, racial and religious prejudices and poisoned rhetoric.
“Democracy can buckle when we give into fear,” Obama said. So while the nation must remain vigilant, he added, “We must guard against a weakening of the values that make us who were are.”
The speech was less of a State of the Union-style recitation of his accomplishments than a summoning of the spirit of a badly demoralized Democratic Party. The Democrats suffered one of their worst drubbings in the Nov. 8 election, essentially solidifying Republicans’ control of the Senate and House while losing the presidency.
Despite his numerous setbacks on the domestic and foreign front – with many of his environmental and regulatory initiatives tied up in court and his strategy for dealing with the civil war in Syria and the Middle Eastern hot spots in shambles – Obama couldn’t resist recalling some of the victories, especially his success in pulling the country out of the worst financial crisis and recession in modern history.
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“If I had told you eight years ago that America would reverse a great recession, reboot our auto industry and unleash the longest stretch of job creation in our history ... If I had told you we would open a new chapter with the Cuban people, shut down Iran’s nuclear weapons without firing a shot and take out the mastermind of 9/11 ... you might have said our sights were set a little too high.”
However, he had almost nothing to say about the Affordable Care Act – his centerpiece domestic legislation that is likely to define his legacy more than any other program. More than six years after Obama and the Democrats enacted the program without a single GOP vote in the House or Senate, the program remains highly controversial with the public at large.
Polls have consistently shown that a majority of Americans don’t approve of the legislation, although most would prefer to see the program fixed instead of repealed. While the program was highly ambitious and addressed a real need for millions of families that have struggled without coverage for years, Obamacare suffered a disastrous, glitch-filled on-line launch four years ago. One problem was that the plan didn’t match its promises -- including Obama’s pledge that beneficiaries could keep their doctors, there would be plenty of insurance options and that premiums and copayments would be highly affordable.
Even while millions of people subsequently benefitted from the subsidized private health insurance plans sold on government-run markets or expanded Medicaid coverage in 31 states and the District of Columbia, the coverage turned out to be a lot more costly in many areas of the country, nearly two dozen experimental insurance co-ops went out of business and major insurers including Aetna, UnitedHealthcare and Blue Cross-Blue Shield pulled out of the program following losses of tens of millions of dollars.
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From the very start, Republicans – goaded on by McConnell and former House Speaker John Boehner of Ohio – denounced Obamacare and staged a series of more than 50 votes over the years to try to repeal the legislation. Rather than seeking to work with the Democrats to fix some of the more glaring problems with the program, they demanded to eviscerate Obamacare and replace it with a less ambitious, more market-oriented program.
McConnell’s take-no-prisoners approach to health care, in which he kept the Republicans united in opposition to Obamacare and sought to thwart the rest of the president’s agenda, proved to be a fateful pivot that impacted Obama’s administration and the Democrats’ political fortunes for the remainder of his time in office.
Or as Mike DeBonis of The Washington Post wrote Wednesday, it was the point at which “the audacity of hope gave way to the reality and frustrations of divided government.” Obama would subsequently sign one more major piece of legislation – the Dodd-Frank financial reform law – and a fiscal stimulus to try to revive the economy. But after that, the Democrats lost control of the House and the last six years in office were focused largely on budgetary disputes with Congress over spending levels and the debt ceiling.
By the last year of his administration, DeBonis noted, Obama’s party had lost 14 Senate seats, 68 House seats, 12 governorship and hundreds of state legislative seats.
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Now, on his way out the door, Obama is being treated to the spectacle of House and Senate GOP leaders rushing to repeal Obamacare in the coming weeks, even without a solid replacement plan in hand. The Senate and House are scheduled to take the first important votes towards that end later this week. And by the end of the month, the GOP-dominated Congress may give final approval to legislation that would dismantle most of the key elements of Obamacare, although the effective date may be months or years away.
If Obama can take any solace from the situation, McConnell and Ryan are discovering that repealing and replacing Obamacare isn’t nearly as easy as they thought. Now a growing number of Republicans in the House and Senate are having second thoughts about the effort, fearing a voter backlash if their efforts result in millions of Americans losing their health insurance and major insurers and hospitals incurring significant financial losses.
