Barack Obama had achieved what no other Democratic president since Franklin Roosevelt could claim: he’d passed a major health care reform package through the Senate. What made the achievement more impressive was that he had done it not only in his first term, as he promised, but in his first year in office. After the Christmas Eve vote, almost everyone in the White House could see the finish line—or so they thought. Remember the cliché, the light at the end of the tunnel could very well be a freight train.
But a Senate vote alone doesn’t make a bill, and the finish line came after a hurdle called the House of Representatives. Despite a big House majority, led with an almost iron fist by Speaker Nancy Pelosi, the White House was having trouble convincing a number of pro-life conservative Democrats to drop objections over public funding for abortions. Any change in the bill would mean a conference committee, made up of representatives from both chambers, then a vote on the compromise that emerged.
It meant, in short, more time for Republicans to drum up opposition to the bill, rally their troops, raise money with direct-mail campaigns, and swing public opinion to their side. With November’s midterm elections less than a year away, the White House staff was beginning to feel as nervous as their fellow Democrats in Congress. To some, even those who had dedicated their entire White House tenure to passing health care reform, a successful outcome was becoming greater than the sum of its parts.
In fact, political expediency—writing a bill that could pass, rather than the perfect bill—had always weighed on the minds in the White House. Some elements of the legislation were included, and others excluded, for the sake of winning votes. “There was never an issue that was in the bill that was more important than just passing the bill,” said Neera Tanden, who had a role in crafting both the legislation and the legislative strategy.
President Obama had wanted to include malpractice reform in the legislation, a critical issue to Republicans from the beginning, back when his advisors still believed Republican votes could be won over. Phil Schiliro, the White House’s chief liaison to Congress, told Obama that Democrats in the House would never back malpractice reform, given the sway trial lawyers hold over the Democratic Party. So Obama barely even tried, simply agreeing to a few pilot programs, but this was among the bigger missed opportunities for Obama to look like he had the upper hand in trying to win over GOP support. Olympia Snowe’s insistence on a trigger, rather than a straight-out public option, caused friction within the more liberal elements of the Democratic Caucus, too, though Obama shouted down his own troops on this one since Snowe was their best chance at getting even a potential public plan into the final bill.
But sometimes House Democrats resisted no matter how many times they were told. The issue of covering undocumented immigrants was something the president himself said he was against. He made that commitment in the campaign. And yet it wasn’t until a Republican congressman named Joe Wilson yelled “You lie!” during an Obama speech before Congress that the White House and Senate Democrats finally convinced House Democrats to get rid of the provision that would have allowed undocumented immigrants to be covered on insurance policies bought through the exchanges. This was just one of many instances where, if the White House had used a heavier hand in drafting the legislation, they would have avoided some political pain. The issue with immigrants was a self-inflicted wound. Of course, many folks allowed these disagreements between the House and Senate to exist for the short term because eventually the two bills would be merged in something called a conference committee, or so they thought. As far as the White House was concerned, they weren’t going to play the role of the heavy until then. But then a new hurdle arose.
As the year 2010 began and the Senate mess was behind them, and some Democrats were preparing for a signing ceremony, Rahm Emanuel and David Axelrod began hearing from friends outside the White House that they might have a more pressing problem than the November midterms. Up in Massachusetts, something was going wrong with what should have been a gimme special election.
Since November, when the two parties had nominated their respective candidates for Senator Kennedy’s seat, the National Republican Senatorial Committee had been quietly funneling money to a state senator named Scott Brown; soon, Brown was showing up on Fox News, and conservative commentators and bloggers were touting his chances as the filibuster-preserving 41st Republican vote in the Senate. Meanwhile, kinks were still being worked out of the House bill, and there was no hope that a conference committee would finish negotiations before January 19, when the Massachusetts special election would be held—meaning that there was a very real chance that any major alteration to the Senate bill was going to have to be voted on in the Senate again, and without a 60th Democratic vote, there would be a problem.
Democrats around Washington weren’t worried. They had nominated Martha Coakley, Massachusetts’s attorney general, a woman who had won the Commonwealth’s top law enforcement job with a whopping 73 percent of the vote. It was a great spot to start from. The attorney general’s office is traditionally a routine stepping-stone to higher office. An attorney general gets to collar crooks, fight on behalf of the citizens of his or her state, take on corporations, and, in Coakley’s case, take the Environmental Protection Agency to task for dragging its feet on greenhouse gas emissions. It is as close to the perfect political job as exists in the United States—one with a huge number of upsides and only a small handful of pitfalls.
It thus came as an unwelcome surprise to Axelrod and Emanuel when rumors started percolating down from Boston that Coakley’s campaign was in trouble.
In fact, Coakley proved to be a disastrous candidate. To start, after winning the Democratic primary in late 2009 she took a vacation, thinking as many in Washington did that the general election was a foregone conclusion; the primary in deep-blue Massachusetts was supposed to be the game. But given how many times Republicans have shocked Democrats in the state—think Mitt Romney or Bill Weld—smart Democrats should have known better. There has always been a quirky independent streak in the Massachusetts electorate. If Democrats get too cocky, they are bitten by this part of the electorate. The vacation decision was Coakley getting cocky. Then on her first fund-raising trip to Washington, a top advisor bodychecked a conservative reporter into a fence. The footage a Republican tracker had taken quickly appeared in advertising financed by the National Republican Senatorial Committee.
Scott Brown, meanwhile, was no ordinary Republican. Republicans who have had success in Massachusetts in recent decades have been businessmen of the Boston Brahmin type: Paul Cellucci, William Weld, Mitt Romney. Brown was the opposite; his Carhartt jacket and pickup truck demonstrated a blue-collar outlook, and his model good looks—Cosmopolitan named him America’s Sexiest Man in 1982—gave him an appeal well beyond the traditional Republican base in the ultraliberal state, never mind that his pickup was used to haul his daughter’s horse around, or that his wife was a well-known news anchor in Boston.
Quickly, Brown became such a cause célèbre among conservative activists that he began raising massive amounts of money online, literally pulling in cash so fast his strategists couldn’t use it all. Brown’s campaign ended with more than $7 million in the bank, simply because there hadn’t been time to send more direct-mail pieces or buy more advertising on television.
The White House watched in horror as Coakley’s campaign flatlined. In early January, White House political director Patrick Gaspard brought a frightening poll to the morning staff meeting, a survey that showed her trailing. The Democratic Senatorial Campaign Committee’s surveys showed the same result. Time was basically running out. “We knew, there was just nothing you could do about it. The DSCC knew, we knew,” one Obama advisor lamented to me.1
Then, too, the media began to take notice, and Gibbs began getting questions, both during the televised daily briefing and in private conversations with reporters, about whether Obama would travel to Massachusetts to campaign for Coakley. The media often reads far too much into special elections, in which a single outcome in one isolated part of the country is extrapolated to the rest of America, but this time the crystal ball was all too clear: if a Republican won a Senate election in a state that hadn’t elected a Republican senator since 1972, a state Obama had won with 61.8 percent of the vote, there was no mistaking that the unpopularity of Obama’s health care bill—and, by extension, of Obama himself—was at least partly to blame.
Some White House advisors, Emanuel chief among them, didn’t want Obama going off to fight a battle he couldn’t win. Emanuel resisted the idea of sending Obama to a rally with Coakley if that appearance would make it more obvious that either the president’s agenda was partly to blame for Coakley’s troubles or that the president had picked a fight and lost.
Gibbs (and others) disagreed. He told the press for a week that Obama had no plans to campaign for Coakley, but he would leave the podium and argue the opposite case in senior staff meetings. “What do you mean, we’re not going to Massachusetts?” he remembers asking. “We have to go to Massachusetts!”
In the end, Gibbs and his allies won the fight. “I never lied, but my theory of this was, okay, health care is at stake,” Gibbs recalled later. “If she doesn’t win, someone’s going to say, ‘Jesus Fucking Christ, health care was on the line and you couldn’t go to fucking Boston for a rally?’ ”
Obama traveled to Boston to hold a last-minute rally with Coakley on Sunday, January 17, to no avail. That same day, when Emanuel ran into a reporter at a bar on Capitol Hill, he was glum. “Do you think she’s going to win?” he asked. The reporter said yes. Emanuel shook his head.2
On January 19, Brown won by 110,000 votes, or about five percentage points—enough to deny Democrats their filibuster-proof 60-vote margin in the Senate. He was sworn in sixteen days later, on February 4, 2010.
Brown’s victory was the exclamation point on a sentence written months before. Polls showed a big plurality of Americans thought the White House was spending too much time on health care in the first place; by January 23, four days after Brown was elected, 46 percent of Americans said Obama’s health care plan was a bad idea, while just 31 percent thought the opposite.3
Reforming such a massive sector of American life was always going to pose a public opinion problem for the White House. After all, the vast majority of Americans already had health care coverage, and by and large they were happy with it. There was an irony in the word “universal”—the only part of the universe that doesn’t already have coverage is a slim segment at the margins of society, a.k.a. folks who are not swing voters; in fact, many are not voters at all. That meant the average American was hearing all about a government takeover of a sector they pretty much had come to rely on even if they weren’t happy with the rising costs. But as the debate steered away from keeping costs down and instead focused on getting more people covered, those with health insurance began thinking that someone else was getting something new, while their own coverage was changing in a way that wasn’t terribly clear, given the confusing Washington-speak coming from the White House.
And yet, for all their political acumen, there was a certain degree of confusion—especially regarding misreading polling results—that went on among the White House staff as well. During the 2008 campaign, the team had played it perfectly—Obama opposed an individual mandate, which played well among general election voters. He opposed McCain’s tax on Cadillac insurance plans, which was also where the country happened to be. But the final version of health care reform included both a mandate, to cover more people, and a tax, to make sure the mandate was paid for.
“His reaction to the mandate was not poll-driven, it was instinctual. He became convinced by the policy people when he got there that there was no other way to achieve the big goal of getting people with preexisting conditions coverage unless everybody was in the pool,” said David Axelrod. “Romney [the author of a similar measure in Massachusetts] was right about that.” In theory, there is something welcome in a politician who does not make his decisions based on polls, and for better or for worse, this was definitely an “in theory” president. But what was left unsaid was that the president, in 2008 as a candidate, had learned how it is a lot easier to win an argument on health care by being against a proposal than it is about championing one.
Brown’s election set the White House scrambling to salvage its yearlong effort. But this new effort looked a lot more like survival mode than anything else. Once again, Emanuel preached caution; he simply wanted to get something, anything, passed, just to get health care off the table. A win, in his mind, would be turning to some other issue—any other issue—and stopping the bleeding on health care. Emanuel considered winning ugly a better option than losing. “Mr. President, you’ve got the rest of the agenda. This is like seven more months [of work],” he said at one meeting. “Scale it back. You’ll get a win.”
Obama was open to the concept of something smaller, like health insurance reform—do preexisting conditions, force policies to accept children up to age twenty-six, and that’s about it. But Pelosi decided she had had enough. She lobbied Obama furiously, demanding that the White House stick to its guns and take the political risks her own members were taking by repeatedly siding with Obama on big-ticket agenda items.
“We’re in the majority,” Pelosi told Obama at one point. “We’ll never have a better majority in your presidency in numbers than we’ve got right now. We can make this work.”4 In a conference call with members of the House Democratic Caucus, Pelosi even took shots at Emanuel’s approach, dubbing it “Kiddie Care” and labeling Emanuel an “incrementalist.”5
Though he had been making the case for health care reform for a year, Obama tried one more PR stunt to get public opinion back on his side. He called House and Senate leaders to the White House a month later, on February 25, to try again to find some Republican votes for his proposal. The summit, held at Blair House, across the street, did not go well. Obama had attended a House Republican Conference retreat in Baltimore the week before, and he’d used the opportunity to lecture the GOP while Republican congressmen threw him canned questions. It was a public relations win for the White House and an embarrassment for House Republicans. The second time around, Republicans decided, they would not ask questions; instead, they would outline their proposal and stay respectful, but they would give no ground.
At the meeting, Obama offered an opening statement, then turned to House Republican leader John Boehner and Senate minority leader Mitch McConnell.
“I just want to say again how much I appreciate everybody for participating. And I am going to now turn it over to Senator McConnell so that he can make some opening remarks. And we’ll just go back and forth between the Democratic leaders and the Republican leaders, House and Senate, and then we’ll just open it up and we’ll start diving in. All right?” Obama said.
McConnell threw a curveball. “Thank you very much, Mr. President. John Boehner and I have selected Lamar Alexander of Tennessee to make our opening framing statement, and let me turn to him.”
Obama and Alexander went back and forth over the intricacies of the legislation, and in the following months, Alexander, who was no Tea Party conservative by any definition, would use a Fox News clip of one particular exchange—over whether the legislation would cost middle-class families more money—to show off to conservative audiences in his home state. Tennessee Republicans ate it up just as voraciously as Tea Party conservatives around the country.
Once again, the White House learned the hard way that there would be no Republican support for its bill. Any changes in the House bill would lead to a conference committee, which would then require another Senate vote. But while the Senate-passed bill would be the only available vehicle to get reform across the finish line, now that Brown—who took to signing autographs as “Brown 41”—was in office, Democrats couldn’t muster the votes necessary in the Senate to overcome a certain Republican filibuster.
It also meant that Stupak and his group of seven pro-life Democrats had new leverage. Stupak had almost derailed the first House-passed version of the bill over concerns about public funding for abortions; Pelosi had salvaged it, and assuaged Stupak, by adopting a last-minute amendment to disallow any such funding.
This time, to win over Stupak’s group, White House counsel Bob Bauer went through weeks of agonizing negotiations that would get the pro-lifers’ support without requiring a new Senate vote. The solution: Executive Order 13535, which cemented restrictions on public funding for abortions first laid down under the Hyde Amendment. Obama, who won election with support from pro-choice groups that make up part of the Democratic Party’s backbone, had to reaffirm one of the pro-life movement’s most sacred touchstones just to save his legislation.
In this case, Stupak spent days reviewing drafts of the executive order and negotiating word changes. Finally, on the afternoon of Sunday, March 21, he appeared before reporters at the Capitol to say he would vote for the measure, putting Democrats over the majority threshold they needed to pass a bill into law. Stupak then went to the floor of the House, where he made his case; a Republican interrupted him, calling him a baby killer.6 But the House vote passed, by a margin of 219 to 212 votes. Two days later, Obama stepped up to the podium in the White House to sign the Affordable Care Act. The president looked relieved, and for good reason.
Some of his allies were not so relieved—quite the opposite. Obama’s decision to include in the bill two elements he had specifically campaigned against—Hillary’s mandate and McCain’s tax credit—had even his closest allies shaking their heads in dismay. Some saw the individual mandate as inconsistent with Obama’s overall message of individual empowerment. “You can think of this in a lowbrow way: someone should have thought about the politics of the mandate,” said one former administration insider. “Or you can think about it in the highbrow way: there’s a democratic legitimacy to the idea that if you campaigned on the fact that I’m not going to do [the mandate], then you shouldn’t do it.”7
More than any other battle during the first term, what the fight over health care reform taught the White House was that Washington had changed, in two key ways. First, the White House was learning that the loyal opposition had become, simply, the opposition. Earlier administrations had willing partners to work with; Bill Clinton got welfare reform through a Republican-controlled Congress, and George W. Bush worked with Ted Kennedy to pass sweeping education reform measures. But after initial flirtations with Snowe and Grassley, the White House had nowhere else to go.
Second, it had fewer tools at its disposal than ever before. The president’s insistence on limiting earmarks, and his own distaste for the grip-and-grin method of influencing supporters, meant that the White House gave up some of the time-tested methods for winning votes. No longer could the White House promise a big-ticket item—a bridge, a highway, an overpass—to a wavering member of Congress. Nor was that member of Congress likely to get a phone call or an invitation to a White House cocktail party, either. Those cocktail parties ended after just a few months, and the phone calls rarely came from the president himself. Then when the high-road team did cut a deal, as it did for Nelson and Landrieu, its hypocrisy highlighted what was once simply the cost of practicing politics.
Most of all, the yearlong fight for health care reform opened wounds that would never completely heal. Inside the White House, Obama gave credit to Nancy-Ann DeParle, the health care czar who had taken on part of the job Tom Daschle was supposed to do. That caused friction among the other nine or ten senior staffers tasked with passing reform, most of whom believed DeParle was getting credit for their work.
Exhausted, Neera Tanden left the West Wing to run the Center for American Progress, a liberal think tank. Emanuel departed before the 2010 midterm elections to begin preparing to run for mayor of Chicago, his hometown. The economic team began to turn over as well.
But they’d made their mark. The Affordable Care Act, the biggest expansion of government since the 1960s, was going to change the health care industry. The White House and its allies will acknowledge they didn’t get a perfect bill, and its compromises forced Obama to stray dangerously near a line his team had always been wary of crossing. Obama’s political appeal lies in the fact that he doesn’t actually appear to be a politician; he says what he means and does what he says. The notion that Obama had governed as he’d promised in the 2008 campaign became a key undercurrent during his 2012 run for re-election. But that notion was dead: by adopting Clinton’s mandate and McCain’s tax, both of which he’d campaigned against, Obama was acting just like any other flip-flopping politician. What was worse was that the flip-flops came in such a politically inefficient manner. That is, Obama abandoned positions that were in line with public opinion in favor of positions that his policy people liked but that the average American opposed.
But, as Emanuel said, making deals comes with the territory. And Obama did in fact achieve a sweeping entitlement program that had eluded every Democratic president since Lyndon Johnson signed Medicare and Medicaid into law. Joe Biden, as usual, said it best. As he introduced Obama at the March 23 press conference, he turned to shake the president’s hand while the audience applauded. Thinking that his words would be drowned out, Biden leaned toward the president’s ear. “This is a big fucking deal,” he said.
It was, though perhaps not in the manner Obama and his team had envisioned. Health care took up a year of the administration’s time, a year in which any number of other agenda items could have made headway. White House advisors routinely blame the length of the debate for costing them chances to reform the nation’s immigration system or pursue a climate change package that actually could have passed the Senate.
But Biden’s comments, picked up by the surrounding microphones, would have a different resonance years later, when “Obamacare”—a term Republicans adopted early to pin the legislation on the president—was rolled out to the public. Then, too, it would be a “big fucking deal”—in the worst way.