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At the time, the nation remained beset by the economic turmoil sparked by the 2008 global financial meltdown, and many wondered whether health-care reform should be the top priority.“I begged him not to do this,” former chief of staff Rahm Emanuel told a reporter in 2010, airing his preference for a hard focus on jobs and the economy even after the passage of the stimulus bill.In the moments before Barack Obama prepared to sign the health-care reform law that would forever define his domestic legacy, Joe Biden famously whispered into his ear: “This is a big [expletive] deal.” On that day, just 14 months into Obama’s presidency, Biden could not know just how profoundly correct he was in that assessment.
In return, the law created new mechanisms to allow access to affordable insurance to millions who had been priced out of the market.
New restrictions would keep employers and insurers from excluding the sick; a system of subsidized state exchanges would serve individuals without access to insurance through their jobs; and an expansion of Medicaid would cover a swath of Americans teetering above the poverty line.
None of those bills would pass the 111th Congress, even though for the first time in more than 40 years one party held the presidency and dominant majorities in both houses of Congress.
The passage of the health-care law meant that, for the first time, Americans would be legally obligated to purchase insurance under the threat of tax penalties.
Could health-care reform have been done in a different way?
Could Democrats have kept control of Congress for another two years or more? The debate roiled Democrats, including some inside the administration, from the earliest days of the presidency.
Then-House Speaker Nancy Pelosi (D-Calif.) walks to the Capitol with Rep.
John Lewis (D-Ga.), second from left, and others on March 21, 2010, ahead of a vote on the health-care law.
“I’ve got a pen, and I’ve got a phone,” he said in 2014, describing his levers of power as his dealings with Congress continued to deteriorate.
Thus, Obama’s legislative legacy comes down to this question: What if?