The Patient Protection and Affordable Healthcare Act means a lot of different things to a lot of different people. This disparity of opinion exists even within the group of lawmakers that created it. A much disputed, and bitterly debated, bill that was signed into law in 2010 by President Barack Obama. It is understandable that a bill of its scope would bitterly divide the nation amongst opinion polls and national surveys. Newsweek declared it “America’s Most Divisive Issue” (Kliff). This bitter divide even separates the opinions of Democrat voters as their party leaders cheer and promote the bill in an effort to improve its public reception. The final Senate bill, as amended by the House, promised affordable healthcare among many other provisions but without the presence of the much debated public option . This was a bill that evolved way too fast within the legislative process of back and forth negotiations between factions within the House and the Senate leading to its timid reception by a skeptic public that was hardened by media coverage of the legislation.
After obtaining majority status in the Senate and winning the White House in 2008 elections while retaining their control of the House, the leaders of the Democrat party planned to spearhead the issue of healthcare reform as the pinnacle of their agenda. But the party itself was divided on many aspects of what healthcare reform should pertain to. Also, the memory of stinging defeat from a 1993 attempt to reform still haunted many of the lawmaker’s minds. One of the underlining causes of their failed 1993 attempt at reform was competing proposals from within their own party. A public perception of party unity on the issue was very important this time around to help shape the media narrative on this massive legislative effort.
This recent reform effort began to gain momentum legislatively when H.R. 3962 passed the House in November 2009. Later, in December 2009 the Senate would pass a more conservative bill of their own, H.R. 3590. The House would then in March 2010 pass H.R. 4872 through reconciliation to amend H.R. 3590 and these were sent to the President to sign. Further complicating this, H.R. 3590 was introduced and passed as a bill in the House with entirely different intentions. This paragraph simplifies a process that begs volumes in order to properly map out its journey into law. This was a complex process that a twenty four hour news cycle media could not be relied upon solely in order to appreciate each step of this reform’s history. Something this intricate was a golden opportunity for any and all to mislead and inject their own bias under the veil of just being the messenger.
The interesting aspect of this legislation was it transcended the usual left vs right or liberal vs conservative protocol of political discourse. This time there were degrees of opinions and perspectives battling it out within each party and amongst independents. There were several wild card variables that split the usual groups into even smaller ones; each defending their position diligently. These volatile variables were: single payer system, public option, federal funding of abortion, and the individual mandate, among others. I consider the debate and the eventual exclusion of the public option the most critical because it bitterly divided the Democrat voter’s opinion. Another variable to consider is that, despite their majority in the Senate, many Democrats in the legislative body were centrist, or moderate, politically. Bills introduced along the majority party’s agenda were not arbitrarily passed without issue as some pundits would lead one to believe. This was especially true in the incidence of a Republican filibuster, in which the Democrats would need a two-thirds majority to override. This body features fiscally conservative Democrats rubbing elbows with those that would love to see a government funded public insurance option for all citizens. This was not just an incidence of differences in opinion, it was the clashing of principles on a national platform that would be observed for decades if the reform effort were successful.
This clash of principles in the Senate was further complicated by the unfortunate death of Senator Ted Kennedy. His replacement in a special election held January 2010 was Scott Brown, who outwardly opposed any government option to be included in healthcare reform (On The Issues). He was also publicly opposed to any use of government funding for abortions as a result of this reform. Massachusetts voters, with their own universal healthcare system in place, supported Brown and responded to his campaign theme of their state having to subsidize a national system in addition to their own. Brown said during his campaign, “We already have almost 98 percent of our people insured, and this national plan will just crush Massachusetts businesses…” (Real Clear Politics). This sudden change in the dynamics of the Senate seemed to doom the House version of reform, H.R.3962. Brown declared that he would be the 41st nay vote if a vote to end filibuster on H.R.3590 came up in the Senate (Brownstein).
Following this, the intricate healthcare reform effort entered another dimension of complexity. Largely through the efforts of then Democrat House Speaker Nancy Pelosi, the House was able to amend the Senate bill H.R.3590 through budget reconciliation rules and pass both it and H.R.4872 to the President for signature into law. Causing this to become additionally complicated and difficult for the lay voter to understand, the text of H.R.3962 was sent to satisfy the text requirement of the budget reconciliation process. This was done despite the fact that H.R.3962 was not even intended to become law, the real text of the intended to pass bill would be amended within the rules committee. Also included was H.R. 3221, or the Student Aid and Fiscal Responsibility Act. Included in this bill was a provision to transition student loans from private lenders to direct government loans. This inclusion was important because of the CBO analysis indicating that it could potentially cut the federal deficit by $87 billion over 10 years. By including this, Democrats were also able to comply with the one reconciliation bill a year rule. Now they were able to ensure passage with an up-down vote in the House on amending the Senate bill being that they lacked the 60 vote threshold to overcome a filibuster in the Senate.
This use of reconciliation was vilified by some in the media. However, to many Washington insiders it was business as usual (Klein). This same procedural tactic was used in 2001, 2003, and 2005 by the GOP to pass Bush tax cuts through each body. In fact, the tactic is used by each party and has for some time. But these bills were not simple tax cuts that were an easy sell to the American public. They contained many changes to an already confusing healthcare system. Despite its commonplace in Washington politics, the use of reconciliation for the passage of healthcare reform further eroded the public’s trust because this provided yet another avenue of negative sentiments toward the reform for its critics. It also seemed to give validation to the claim that the reform process was lacking in the form of bipartisanship. David Axelrod, Senior Adviser to the President from January 2009 to January 2011, said the following in response to Republicans in the Senate complaining of a lack of bipartisan input on the process, “If you’re sitting at a table negotiating in good faith, then you probably don’t send out mailers saying, ‘Help me stop Obama-care.’ That’s just common sense” (Wenstein et al). A lot was at stake for each party and the tensions were understandably high during the entire process.
The issue of including the public option or not in the reform helped fuel these tensions. Many conservative Democrats even joined the Republicans in opposition to this proposed provision. It was not enough to stop a public option from being included in the House bill, H.R. 3962. But once the dynamic of the Senate changed following the January 2010 special election of Senator Scott Brown, the more conservative bill which lacked a public option became the best strategic option for reform to survive. President Obama, who was largely responsible for representing the bill publicly, had campaigned on the idea of a public option possibly being implemented by his administration. Now he was in a position to explain to a skeptical public that due to a change of plans his main promise would not be kept. Not surprisingly, this further divided the opinion of the more liberal Democrat voters from the more centrist ones (Jones).
These tensions within the Democrat party spilled into a White House press briefing by then Press Secretary Robert Gibbs in August 2010 when he made the following comment in reference to the “professional-left”: “They will be satisfied when we have Canadian healthcare and we’ve eliminated the Pentagon. That’s not reality.” He went on to say, “They wouldn’t be satisfied if Dennis Kucinich was president” (Youngman). Youngman notes that this dismissal is along the lines of the criticisms from the right. This was a public testament to the distrust and turmoil within the party and the lack of a unified message as to what healthcare reform should be, and how it should be obtained. This infighting was naturally noticed by the media and reflected in polls.
Slate columnist Ron Rosenbaum notes the application of framing theory by UC-Berkely linguist George Lakoff to advise Democrats “that their problem is not their policies but the words they use to describe them” (Rosenbaum). He insists that the use of the words “public option” has created harm for the Democrats reform efforts. Pollsters could easily frame the debate manipulating this much misunderstood term. He goes on to to say:
Most polls show that Americans are evenly divided on or opposed to Obama’s overall health care plan, of which the public option is, or was, the heart. And a Times Poll of Sept. 24 shows that a 55 percent majority believes the White House has failed to explain its health care reforms adequately. Fifty-five percent, many of whom would be in favor if the reforms were presented to them in plain language and who would be putting pressure on their reps to pass it. Imagine if health care proponents had explained it clearly in the beginning!
Depending how the question on healthcare reform was framed for the respondent, different conclusions on the public perception of the reform could be supported. This makes judging actual public opinion on the issue difficult and unpredictable. Claims of polls indicating majority public support and majority public dissent on the issue were readily available to media consumers at the same time. This further eroded any efforts by Democrats to control the narrative on the reform following its passage.
One could argue that even if this legislation had a clean pass through both Houses, with or without the public option in tact, there would still be much public scrutiny. Many of these claims are centered around the constitutionality of the legislation; particularly the individual mandate. This was a requirement of citizens to obtain health insurance coverage or be subject to a tax penalty. President Obama, when asked about recent rulings on healthcare reform in lower courts, said “That’s the nature of these things. When Social Security was passed, there were all kinds of lawsuits. When the Civil Rights Act was passed and the Voting Rights Act was passed, there were all kinds of lawsuits” ( Tampa Bay Online). St. Petersburg Time’s Politifact analyzed and rated this comment as true based on the history of lawsuits quickly following the passage of these historic legislative efforts (Politifact). But this dismissive stance will be tested when the Supreme Court eventually reviews and makes a ruling relevant to the legislation.
In the end, barring any opposing court rulings, the reform effort did prove successful. But this definition of success on the issue is highly subjective. The struggle to capture the public opinion on the issue continues and is showing minimal improvements. This bill will either fall victim to its opposition in the courts, the actions of the Republican party, or it will have to win over public opinion as Social Security eventually did. The idealism behind this legislation has faced tough obstacles and changes by the 112th Congress are highly likely to occur. Almost a year after passage, this bill continues to evolve along with the public’s perception of it.
Newsweek – Gallup Poll – Health Care Reform