Thanks, Obama: Political and Policy Lessons from the Quest for National Health Insurance

Health care reform with the goal of universal coverage, or near universal coverage, in the United States, has been an objective of reform advocates and presidential administrations over the course of the last century. Incremental changes have been made to the system, primarily through the creation of Medicare and Medicaid, but historically, comprehensive reform has either failed or been deemed impossible. Why was President Obama the first president to successfully overhaul the system when the window for reform was open for one of his recent predecessors, President Bill Clinton? In this paper I argue that President Obama’s leadership, and willingness to take a moderate stance on specific provisions of the Patient Protection and Affordable Care Act (ACA) during the negotiation process, allowed him to correct for the mistakes of the Clinton administration. I contend that the primary corrections made by Obama that secured passage of the ACA, while not exhaustive, are: timing, transparency, issue-framing, personality and leadership, and the inclusion of stakeholders. This paper highlights the importance of these corrections and uses them as an accessible set of lessons for policymakers and political scientists to consider during future reform efforts.