Health Care Reform: Act One, The legacy of the 2008 election

Despite this mandate, however, the passage ofhealth care reform was long, arduous and not very pretty. The 2008 election also reflected a deepening polarization in the country that would have ramifications for the 2010 and 2012 elections: voters in red states were dead set against health care reform, big federal programs and increasing taxes; voters in blue states saw the charismatic President as the symbol of hope and change, and were themselves hopeful of a new beginning, a new era of government activity for the good of society. Voters in the so-called “purple” (swing) states were divided between the camps. As the President was inaugurated in 2009, however, the mood of the country was upbeat, and even his opponents saw the change in administration as a hopeful new beginning.

Hoping to continue to distance himself from Hillary Clinton’s failures, President Obama refused to get involved in the nuts and bolts of the legislative process.7 Though the blue dog Democrats had been pivotal in giving President Obama his Democratic sweep, they were on the conservative end of the party’s spectrum, and were concerned about cost, the single-payer system and federal funding of abortion (prohibited under the Hyde amendment).8 Republicans, for their part, were leery of any kind of national health care system, and worried about creating a vast new program in an era of skyrocketing debt. It eventually became clear that (1) the President was not going to weigh in on the legislation in any significant way and (2) Republicans were going to be, as a Politico article alleged (and the Democrats liked to repeat), “the party of no.”9 This strategy continued to play out, causing headaches for the President after both the 2010 and 2012 elections.

Speaker of the House Nancy Pelosi (D-CA) and Senate Majority Leader Harry Reid (D-NV) set about creating the coalitions necessary to pass the bill—coalitions that each leader had to build within the Democratic Party. Language appeasing pro-life Democrats was added in the House, and in the Senate special deals (the “cornhusker kickback,” the “Louisiana Purchase”) were made to entice recalcitrant Democrats to vote for the legislation. As 2009 was drawing to a close, health care was moving towards passage. The House and Senate were each voting on different versions of the bill; these versions would eventually need to be combined and reconciled in a conference committee bill that would itself come to a vote in each chamber before going to the President for his signature.

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