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Landmark or footnote? Obamacare legacy now rests with Trump

January 9, 2017 at 6:30 PM EDT
When he signed the Affordable Care Act in 2010, President Obama achieved what politicians had long tried and failed to do: provide near-universal health insurance to Americans. But ever since, it’s faced unflagging Republican opposition. Special correspondent Sarah Varney of Kaiser Health News looks at the history and uncertain fate of the ACA.
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JUDY WOODRUFF: But, first, we continue our series on President Obama’s legacy.

The president has been making the case during the final days of his term to preserve his signature domestic achievement. It comes as congressional Republicans have already begun the process of dismantling the Affordable Care Act. More than 20 million Americans gained coverage through the law.

But as special correspondent Sarah Varney reports, the nation remains deeply divided over whether it is the president’s greatest success or a massive failure.

PRESIDENT BARACK OBAMA: This is going to take a little while…

SARAH VARNEY: When President Obama signed his landmark health care bill in March 2010, he achieved what presidents and members of Congress had long tried and failed to do.

PRESIDENT BARACK OBAMA: We are done.

(CHEERING AND APPLAUSE)

SARAH VARNEY: Provide near-universal health insurance to Americans. Democrats were jubilant. Those in Obama’s inner circle, like Bob Kocher, one of the law’s primary architects, celebrated their victory at the White House.

BOB KOCHER, Former Special Assistant to President Obama: It was a moment of total joy. We felt like we’d accomplished something hard and amazing and important that would go down in history as being an important step forward in American health care.

And the president felt that way, and I think we all celebrated and felt like the hardest part was perhaps behind us.

SARAH VARNEY: Since Harry Truman, every Democratic president has dreamed about universal coverage.

Jonathan Oberlander, a health policy historian at the University of North Carolina at Chapel Hill, says Obama succeeded in winning over health care interest groups that had fought previous reform attempts.

But the bill became a flash point for bigger ideological battles.

JONATHAN OBERLANDER, University of North Carolina, Chapel Hill: In key respects, it was a policy success, but it was also always a political failure since 2010. And that political failure reflects that partisan polarization, which Democrats and the Obama administration never figured out a way to overcome.

SARAH VARNEY: The bill passed without a single Republican vote and would face unflagging opposition. Explosive town hall meetings…

WOMAN: If you let the free market system work, everybody could have insurance.

SARAH VARNEY: Angry Tea Party protests.

PROTESTERS: Obamacare has got to go!

PROTESTERS: What do we want?

PROTESTERS: Health care!

SARAH VARNEY: And a Supreme Court decision in 2012 that, despite upholding most of the law, weakened one of its central provisions by making the Medicaid expansion optional for states.

Senator Charles Grassley, a Republican from Iowa who was involved in the initial bipartisan discussions, said his side turned away after Democrats, who themselves were frustrated by the prolonged negotiations and felt they had a mandate, decided to move forward alone.

SEN. CHARLES GRASSLEY (R-Iowa): It was a take it or leave it, and so, basically, we were pushed out of the negotiations. And, quite frankly, there was a lot of institutional knowledge among Republicans that would’ve probably prevented a lot of bad things that happened going wrong.

I think it’s a perfect example of trying to do something in a partisan way.

SARAH VARNEY: The Obama administration believed the law would eventually become popular as more Americans felt its benefits. But public opinion remained divided. Republicans voted to repeal or delay part or all of it more than 60 times, always facing the prospect of a certain veto from President Obama.

Now president-elect Donald Trump has vowed to kill the law for good.

DONALD TRUMP (R), President-Elect: Repealing Obamacare is one of the single most important reasons we must win on November 8.

SARAH VARNEY: A promise that appealed to many voters around the country.

Here in Mansfield, Ohio, once a booming manufacturing town, the Affordable Care Act has brought insurance coverage, new health care jobs and an influx of federal money. All told, nearly one million Ohioans are covered under Obamacare.

But economic angst in Rust Belt states like this one handed the presidential election to Donald Trump, giving him the power to repeal President Obama’s signature domestic policy.

KARI WESTFIELD: This area was –the kids would get older, graduate, and then leave and not come back.

SARAH VARNEY: What happens next is up for grabs. Kari Westfield helps sign patients up for Medicaid in this Ohio county where Mr. Trump won nearly 70 percent of the vote.

KARI WESTFIELD: The most recent was the GM closing, and that was a huge, huge hit to the economy.

SARAH VARNEY: As manufacturing plants here have closed, nearly 30 percent of residents have had to enroll in Medicaid, which was expanded in Ohio to include most low-income adults under the Affordable Care Act.

Since the health law took effect, the share of uninsured patients at Third Street Family Health Services, where Westfield works, fell from 30 percent to 10 percent.

That includes Larry Avery, a 31-year-old basketball coach who has been rushing to get medical and dental care before Mr. Trump takes the law away.

LARRY AVERY, Patient, Third Street Family Health Services: I just thought it was just a move that he was doing just to make it harder than what it already is. Because, I mean, if it’s working, if it helps, why would you want to take that away? I don’t think it benefits the country at all.

SARAH VARNEY: Among those trying to enroll in Obamacare’s expanded Medicaid are Trump supporters Mary and Jim Heenan. A nurse trying to recover from an opioid addiction, Mary Heenan says she and her husband need help. And though she says it can be difficult to reconcile, Heenan still despises the health law. She says it forced the surgeons she once worked with to provide shoddy medical care.

MARY HEENAN, Patient, Third Street Family Health Services: I know I’m in this spot where I need help right now from the government, but the Affordable Care Act is the worst thing that’s ever happened to this country. And that’s exactly why I voted for Trump. Because I knew Hillary was going to follow in Obama’s footsteps.

SARAH VARNEY: But John Corlett, at the Center for Community Solutions, an Ohio think tank, says other voters didn’t take Mr. Trump’s promise to repeal the law seriously.

JOHN CORLETT, Center for Community Solutions: I think people have a natural inclination to think that, once something starts, that it’s hard to stop — that it’s hard to take down. And I think a lot of people sort of approached it that way, said, ‘Well, no. They wouldn’t do that.’

SARAH VARNEY: Across Ohio, the health law has dramatically reduced the number of people without health insurance. At MetroHealth in Cleveland, as elsewhere in the country, the influx of insured patients has allowed the health system to provide more preventive care and cut costs by nearly 30 percent.

Despite strong opinions about what’s become known as Obamacare, elements of the law remain widely popular. Health plans can’t refuse to insure based on preexisting conditions, and young adults can stay on their parents’ plans until age 26.

PROTESTERS: No repeal without replace.

SARAH VARNEY: Mindy Hedges showed up at a rally outside Senator Rob Portman’s office in Columbus to show how vital the law has been for those with medical problems.

MINDY HEDGES, Diabetes Patient: I’m scared for our country. I’m scared for a lot of reasons.

SARAH VARNEY: Before the health law, she couldn’t get insurance.

MINDY HEDGES: I was so grateful to President Obama. I owe President Obama my life. As a type 1 diabetic, I’m uninsurable as far as the insurance companies are concerned. And now they couldn’t take that into any consideration. And my age, they couldn’t take into consideration.

SARAH VARNEY: Hedges has been calling her congressman and senators every day to make sure they hear her story.

MINDY HEDGES: Will he be supporting keeping it at least until we have something better or at least something to substitute for it?

SARAH VARNEY: But there are others, especially small business owners and the self-employed, who are frustrated by what’s been happening in the insurance marketplaces.

ANIETRA HAMPER, Owner, ThreeWordPress: There do not seem to be a lot of options this year.

SARAH VARNEY: Anietra Hamper is a travel writer who started her own business a few years ago, and says the law made a mess of her coverage.

ANIETRA HAMPER: Every year, there have been fewer providers. There’s fewer plans by the providers that are left. Higher monthly premiums. Deductibles have skyrocketed. And the benefits have dwindled.

SARAH VARNEY: Those frustrations drove Hamper to vote for Mr. Trump, who says he wants to keep the law’s more popular provisions and scrap the rest in favor of a less regulated insurance market.

But health care experts say it will be impossible to pay for those benefits without a mandate that all Americans have coverage. Repealing it with no plan in place, they say, will create chaos in the insurance market and catastrophe at hospitals and clinics.

But Hamper says the law has already done enough damage.

ANIETRA HAMPER: This isn’t working. So, if Donald Trump says he wants to reinstate a free marketplace, where we have more choices, more competition, better care, more affordability, OK. And like every other American, you know, we have to hope that that’s what we get.

SARAH VARNEY: Senator Grassley says it’s too soon to lay out what comes next.

SEN. CHARLES GRASSLEY: Obviously, repeal is very much what’s going to happen. Whether it’s a transition period that it takes a period of time to get total replacement, or whether it’s done incrementally, those decisions have not been made at this point.

SARAH VARNEY: Whatever the outcome, many observers say President Obama’s legacy will forever include his ambitious attempt to solve one of the nation’s most intractable problems.

BOB KOCHER: I think, forever, we have changed the conversation that we need to have an approach to cover all Americans. And, if nothing else, this law now leads Republicans to agree that we need to have an approach to cover all Americans with high-quality insurance. So I think that’s a real accomplishment, and that wouldn’t have happened without this law.

JONATHAN OBERLANDER: Some of the most gifted presidents in the 20th century tried comprehensive health care reform, and they failed. President Obama succeeded. This is not a footnote in history. It will go down as a landmark.

SARAH VARNEY: And one of the most important legacies of the Obama years.

For the “PBS NewsHour” and Kaiser Health News, I’m Sarah Varney.

JUDY WOODRUFF: Tomorrow, we continue our series on the Obama years with a look at the president’s efforts to reform the nation’s criminal justice system.

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