Republican Calculation: Don't Support Obama's Affordable Care Act

When I wrote Monday that we could expect a firehose of misinformation about the Affordable Care Act in the coming months, it didn’t occur to me that some of that misinformation would show up in the comments section of this newsletter. 

I shouldn’t have been surprised because I witnessed firsthand 15 years ago how people formed their opinions about the bill based on what they had heard or read from sources they believed were trustworthy. In far too many cases, those sources were anything but that. My former colleagues in the health insurance business spent millions of dollars to mislead all of us, and an enormous amount of misinformation they generated showed up in the media–and still does.

Further, as I noted on Monday, we humans have faulty memories. We often misremember stuff. 

One of this newsletter’s readers contended that:

The ACA was one of the major platforms of Obama when running to win (his) first term. The reason why there wasn't one Republican vote in favor was because the Democrats told the Republicans to "BUT OUT!" This was a Democrat initiative from the very beginning!

It is true that Obama (and his primary rivals, Hillary Clinton and John Edwards) did run on health care reform in 2008, primarily because the number of uninsured people in this country had increased dramatically over the previous decade, from 40 million to 50 million. Many of those uninsured folks had preexisting conditions and couldn’t buy coverage at any price because insurance companies wouldn’t sell it to them. Many others were dumped when they got sick. 

The rest of what the reader wrote, however, is not correct. Obama and many Congressional leaders hoped and believed that Republicans, at least some of them, would work with Democrats in good faith to arrive at a truly bipartisan bill.

I guess people forget the ACA was modeled on “Romneycare,” which was enacted in Massachusetts in 2006 when Mitt Romney, now a Republican senator from Utah, was governor of the Bay State. I heard Romney talk in glowing terms about the law – and the bipartisan support it attracted in the Massachusetts legislature – at the 2006 annual meeting of America’s Health Insurance Plans (AHIP) in San Diego, two months after he had signed the bill into law. Romney was the keynote speaker at that conference, and his remarks were well-received. Among those who praised Romneycare was California’s Republican governor at the time, Arnold Schwarzenegger.

Debate on what became the ACA began in early March 2009, two months after Obama was inaugurated and four months after he defeated Arizona Sen. John McCain in the 2008 general election. As I wrote in Deadly Spin, Obama officially kicked off the health care reform debate at a March 5, 2009, White House summit, to which he had invited more than 150 members of Congress, health-policy experts, and leaders of groups representing doctors, hospitals, unions, big business, insurance companies, and consumers. 

Despite being modeled on the Massachusetts law, many Republicans in Congress, on the advice of GOP campaign strategists, immediately attacked Obama and Democrats in Congress, calling them socialists hellbent on a “government takeover of health care.” It was no such thing, but it became a talking point that quickly took hold on the right, abetted by the insurance industry, which wasn’t happy with Democrats for suggesting insurers should stop blackballing sick Americans (even for hay fever) and canceling coverage for women after a breast cancer diagnosis. As we noted yesterday, AHIP funneled $100 million to the U.S. Chamber of Commerce to fund the Chamber’s anti-reform PR, advertising, and lobbying campaign.

I made many trips to Washington in 2009 and 2010 as the debate on reform dragged on. I met with Republicans as well as Democrats to encourage them to support reforms that would make insurers use more of our premiums to cover our medical claims and ban business practices that forced more and more of us into the ranks of the uninsured and underinsured. I would go on to testify at three Congressional hearings. 

One of the reasons the debate lasted so long was because former Sen. Max Baucus (D-Montana), who chaired the powerful Finance Committee, kept holding out hope that Republicans on his committee would work with him to craft a bipartisan bill. Some of his key staff had recently held high-level positions in the health insurance industry, so he knew what insurers’ demands were. Not only that, he also received more money in campaign contributions from health and insurance interests than any other member of Congress. He even appointed what came to be known as the Gang of Six, comprising three Democrats and three Republicans, to draft reform legislation. The gang seemed at times to be making progress but ultimately threw in the towel after months of meetings. Baucus would ultimately disband the group, dashing hopes of a bipartisan bill. 

Republican strategists, most notably Frank Luntz, had advised their clients early on not to work with Democrats because they believed their opposition to reform could be a winning campaign talking point in 2010, especially if they called “Obamacare” a “government takeover of health care.” They were right. Democrats lost control of the House and gained six Senate seats in the 2010 midterm elections. PolitiFact would later call Luntz’s government takeover talking point the 2009 “Lie of the Year.”  (Not a lie: Foundational elements of the ACA came from the Heritage Foundation, more recently famous for Project 2025.)

It’s important to note that Baucus was no champion of a government takeover of health care. Far from it. During a Finance Committee hearing in May 2009, he had Capitol police arrest several vocal single-payer supporters. (Eight years later, after he retired, Baucus changed his stance and said Congress should consider Medicare for All.)

There was so much misinformation and confusion about the Affordable Care Act after it was enacted that I wrote an ebook about the law to explain what it did and didn’t do and how it would affect all of us in one way or another. I never imagined I’d still be trying to set the record straight and explain the ACA’s accomplishments and shortcomings all these years later. One thing’s for sure, my former colleagues’ massive misinformation campaign has had legs.