The Volokh Conspiracy

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President Obama on the Twelfth Anniversary of the ACA

The namesake of Obamacare took a victory lap at the White House.


My first book, Unprecedented, told the story of the Affordable Care Act during President Obama's first term, culminating with NFIB v. Sebelius. My second book, Unraveled, recounted the ACA during Obama's second term, including Hobby LobbyKing v. Burwell, and Zubick. I am working on the third book in the trilogy, Undefeated, which recounts the ACA during President Trump's term, and into the Biden administration. This book will focus on Little Sisters of the Poor and California v. Texas, among other topics. From beginning to end, this twelve-year arc represents, I think, the complete debates over the ACA. To be sure, people still will object to Obamacare, but now the law has been woven into the fabric of our society.

Yesterday, former-President Obama visited the White House. And the namesake of the law took a victory lap. His light-hearted remarks offer a useful summary of Obamacare's many twists and turns since 2010.

I think it's been well documented just how difficult it was to pass the ACA.  (Laughter.)  There — there's — you can get a lot of testimony here, in case folks haven't heard.

As a country, we had been talking about reforming healthcare for 100 years.  Unlike almost every other advanced economy on Earth, we didn't have a system that guaranteed access to healthcare for all of its citizens.  Millions of people didn't have health insurance, often because their employers didn't provide it or because it was too expensive.

But despite the fact that our healthcare system didn't work well, it was hard to change.  Healthcare represents about one-fifth of our economy; that's trillions of dollars that are involved.  So there were a lot of different economic interests that were vying to maintain the status quo.

And because the majority of Americans did have healthcare, some people naturally worried that they'd lose what they had.  The media was skeptical of past failures.  There was a lot of misinformation, to say the least, flying around.  And it's fair to say that most Republicans showed little interest in working with us to get anything done.  (Laughter.)  That's fair to say.

But despite great odds, Joe and I were determined, because we'd met too many people on the campaign trail who'd shared their stories, and our own families had been touched by illness.

And as I said to our dear friend Harry Reid, who is missed — wish he was here today, because he took great pride in what we did — I intended to get healthcare passed even if it cost me reelection — which, for a while, it looked like it might.  (Laughter.)

But for all of us — for Joe, for Harry, for Nancy Pelosi, for others — the ACA was an example of why you run for office in the first place, why all of you sign up for doing jobs that pay you less than you can make someplace else; why you're away from home sometimes and you miss some soccer practices or some dance recitals.

Because we don't — we're not supposed to do this just to occupy a seat or to hang on to power.  We're supposed to do this because it's making a difference in the lives of the people who sent us here.

And because of so many people, including a lot of people who are here today, made enormous sacrifices; because members of Congress took courageous votes, including some who knew that their vote would likely cost them their seat; because of the incredible leadership of Nancy and Harry, we got the ACA across the finish line together.  (Applause.)

And the night we passed the ACA — I've said it before — it was a high point of my time here, because it reminded me and it reminded us of what is possible.

But, of course, our work was not finished.  Republicans tried to repeal what we had done — again, and again, and again.  (Laughter.)  And they filed lawsuits that went all the way to the Supreme Court three times.  I see Don Verrilli here who had to defend a couple of them.  (Applause.)

They tried explicitly to make it harder for people to sign up for coverage.

And let's face it: It didn't help that when we first rolled out the ACA, the website didn't work.  (Laughter.)  That was not one of my happiest moments.  (Laughter.)

So, given all the noise and the controversy and the skepticism, it took a while for the American people to understand what we had done.  But lo and behold, a little later than I'd expected, a lot of folks, including many who had initially opposed healthcare reform, came around.

And today, the ACA hasn't just survived; it's pretty darn popular.  And the reason is because it's done what it was supposed to do.  It's made a difference.

First, 20 million and now 30 million people have gotten covered thanks to the ACA.  (Applause.)

It's — it's prevented insurance companies from denying people coverage based on a pre-existing condition.  It's lowered prescription drug costs for 12 million seniors.  It's allowed young people to stay on their parents' plan until they're 26.  It's eliminated lifetime limits on benefits that often put people in a jam.

So, we are incredibly proud of that work.

But the reason we're here today is because President Biden, Vice President Harris, everybody who has worked on this thing understood from the start that the ACA wasn't perfect.  To get the bill passed, we had to make compromises.  We didn't get everything we wanted.  That wasn't a reason not to do it.  If you can get millions of people health coverage and better protection, it is — to quote a famous American — a pretty "big deal."  (Laughter and applause.)  That's what it is.  (Applause.)  A big deal.

But there were gaps to be filled.  Even today, some patients still pay too much for their prescriptions.  Some poor Americans are still falling through the cracks.  In some cases, healthcare subsidies aren't where we want them to be, which means that some working families are still having trouble paying for their coverage.

Here's the thing: That's not unusual when we make major progress in this country.  The original Social Security Act left out entire categories of people, like domestic workers and farm workers.  That had to be changed.  In the beginning, Medicare didn't provide all the benefits that it does today.  That had to be changed.

Throughout history, what you see is that it's important to get something started, to plant a flag, to lay a foundation for further progress.

The analogy I've used about the ACA before is that: In the same way that was true for early forms of Social Security and Medicare, it was a starter home.  (Laughter.)  It secured the principle of universal healthcare, provided help immediately to families.  But it required us to continually build on it and make it better.

And President Biden understands that.  And that's what he's done since the day he took office.  As part of the American Rescue Plan, he lowered the cost of healthcare even further for millions of people.  He made signing up easier.  He made outreach to those who didn't know they could get covered — make sure that they knew; made that a priority.

And as a result of these actions, he helped a record 14.5 million Americans get covered during the most recent enrollment period.  (Applause.)

That, ladies and gentlemen, is what happens when you have an administration that's committed to making a program work.  (Applause.)

And today — today, the Biden-Harris administration is going even further by moving to fix a glitch in the regulations that will lower premiums for nearly 1 million people who need it and allow 200,000 more uninsured Americans get access to coverage.

I'm a private citizen now, but I still take more than a passing interest in the course of our democracy.  (Laughter.)  But I'm outside the arena, and I know how discouraged people can get with Washington — Democrats, Republicans, independents.  Everybody feels frustrated sometimes about what takes place in this town.  Progress feels way too slow sometimes.  Victories are often incomplete.  And in a country as big and as diverse as ours, consensus never comes easily.

But what the Affordable Care Act shows is that if you are driven by the core idea that, together, we can improve the lives of this generation and the next, and if you're persistent — if you stay with it and are willing to work through the obstacles and the criticism and continually improve where you fall short, you can make America better — you can have an impact on millions of lives.  You can help make sure folks don't have to lose their homes when they get sick, that they don't have to worry whether a loved one is going to get the treatment they need.

President Joe Biden understands that.  He has dedicated his life to the proposition that there's something worthy about public service and that the reason to run for office is for days like today.

So, I could not be more honored to be here with him as he writes the next chapter in our story of progress.  I'm grateful for all the people who have been involved in continuing to make the ACA everything it can be.

And it is now my great privilege to introduce the 46th President of the United States, Joe Biden.  (Applause.)