Healthcare - Obama Presidency Oral History

On the campaign trail, Obama had highlighted several legislative goals for his first term. Healthcare reform was among these priorities, but they also included an economic stimulus package to reduce the severity of the recession, financial regulation to prevent future financial crises, comprehensive immigration reform, and major energy and climate change legislation. In their interviews, White House advisors recall their debates about the sequence in which they ought to pursue these priorities in Congress. Many of these advisors were veterans of the Clinton administration, and they drew on the lessons of the healthcare reform effort that had failed in 1994 while devising their strategy. 

One important lesson from the Clinton era was that the success of the legislative effort would likely be determined by the extent to which relevant stakeholders could form, or be organized into, a unified coalition capable of driving a bill through Congress. The project archive sheds light on this challenge from both inside-out and outside-in. Throughout 2009, government officials—in the White House, executive-branch agencies, and Congress—engaged with outside professional associations, nonprofit organizations, and industry interest groups, and they describe hosting Washington summits, negotiating deals, and working to build support for the administration’s strategy. Likewise, outside stakeholders, like Andy Stern of the Service Employees International Union (SEIU), describe their experiences working with government officials, and recount their efforts to coordinate with healthcare providers, insurance companies, and others to form a coalition to advance the legislative process.

Throughout this process, Americans from across the country struggling to cope with the high cost of healthcare shared their experiences, and they advocated for national reform in town hall meetings and in letters to President Obama. Connie Anderson, for instance, recounts her sister Natoma Canfield’s battle with cancer and decision to write to the White House about her struggles with healthcare coverage, while Secretary of Health and Human Services Kathleen Sebelius remembers how Obama incorporated Canfield's letter into policymaking debates.

In addition to discussion of the broad sweep and strategy of healthcare reform, the Obama Presidency Oral History project also provides detailed coverage of the specific policy issues that were central to the development and negotiation of the ACA. Members of Congress and their staffers, administration officials, and outside stakeholders discuss the law’s individual insurance mandate, the defeat of the proposed public insurance option, potential taxes on expensive insurance policies, reproductive healthcare provisions, state Medicaid expansions, and much more. 

These narrators also recount the ACA’s journey through Congress, and speak widely about its politics. Among their discussion of the many topics relevant to this process, they reflect on the division of legislative work between key congressional committees, Democrats’ dogged pursuit of Republican support for their proposals, divisions within the Democratic Party coalition, the relationship between the Obama White House and Congress, the fierce “Tea Party” opposition to healthcare reform that emerged over the summer of 2009, and the challenge of communicating with the public about the complex and technical legislation. 

After the ACA became law in March 2010, the administration’s attention shifted toward its implementation. Officials in federal regulatory agencies recount the process by which the legislative language of the ACA was converted into formal rules, and White House staff focused on community engagement outline their efforts to enroll Americans from diverse backgrounds and walks of life in insurance policies.

Executive branch policymakers also reflect on the construction of online health insurance exchanges and the technical problems that plagued the launch of healthcare.gov, while Americans who were eager to enroll in new plans under the ACA narrate their experiences trying to secure coverage through the new platforms after they came online in October 2013.

From the moment the ACA became law, conservative and Republican-aligned groups mounted legal challenges against the bill. Officials from the Office of the Solicitor General and the White House counsel’s office speak widely about their approach to defending the ACA in court, and provide details about the major Supreme Court cases concerning key provisions of the legislation, including National Federation of Independent Business v. Sebelius (2012) and King v. Burwell (2015). 

Healthcare reform overlaps and intersects with a number of other topic areas in the Obama Presidency Oral History collection, including the financial crisis and economic recession, Republican opposition, public health, and the Supreme Court.