President Obama gave a big speech yesterday about the Affordable Care Act and, while I don’t want to spoil it entirely for you, the gist of it was that he’s a pretty big fan. All the usual pro-ACA bullet points were in there: more people covered, uninsured rate down, no more discrimination based on preexisting conditions, etc. And he took a minute to point out that all the worst predictions from Republicans and conservatives about the havoc and devastation the law would visit upon the nation have not come true. It’s all stuff we’ve heard before and will probably hear again.
But what was interesting about the speech was a point Obama made several times that feels obvious but often gets lost in the constant political bickering over the Affordable Care Act’s still uncertain future: Obamacare is our reality, and it has been for a while now.
Going back to the Clinton administration, conservative efforts to fight Democratic attempts at healthcare reform have been motivated by the fear that once the federal government got involved in expanding access to care, there’d be no going back. That fear was what animated William Kristol’s 1993 memo to Republican leaders warning against any sort of compromise with Bill Clinton on healthcare reform. “It will relegitimize middle-class dependence for ‘security’ on government spending and regulation,” he wrote. “It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.”
The GOP succeeded back then, but left the issue on the table. Obama picked it up, got it done, and yesterday he reminded Republicans and conservatives that in spite of their ongoing and determined opposition to the Affordable Care Act, this long-standing nightmare of theirs is the new normal. “So five years in, what we are talking about it is no longer just a law,” he said. “It’s no longer just a theory. This isn’t even just about the Affordable Care Act or Obamacare. This isn’t about myths or rumors that folks try to sustain. There is a reality that people on the ground day to day are experiencing. Their lives are better.”
The Affordable Care Act is “woven into the fabric of America,” Obama said, putting it on the same plane as programs like Medicare and Social Security that were viciously opposed by the right at their creation, but now exist as critical guarantors of a minimum level of prosperity:
OBAMA: Our history is one of each generation striving to do better and to be better than the last. Just as we’ll never go back to a time when seniors were left to languish in poverty or not have any health insurance in their golden years. There was a generation that didn't have that guarantee of health care. We're not going to go back to a time when our citizens can be denied coverage because of a preexisting condition. When tens of millions of people couldn’t afford decent, affordable care -- that wasn’t a better America. That's not freedom. The freedom to languish in illness, or to be bankrupt because somebody in your family gets stick -- that's not who we are. That's not what we're about.
It’s significant that Obama is saying this now, with a Supreme Court ruling in King v. Burwell set to drop in the next couple of weeks. If the court rules against the government in that case, Obamacare’s subsidies for health insurance premiums will disappear in 34 states and millions of people will be abruptly hurled backward to the days of unaffordable and inaccessible health coverage. Obama is preemptively framing that potential outcome as contrary not just to our shared morals, but to the American ideal of working to steadily improve the lives of each succeeding generation. These remarks weren’t made to try and influence the outcome of the case, but rather to lay down a marker for how the fight will play out politically if the court sides with the ACA's challengers.
As Greg Sargent points out, this message is meant to undermine the rhetoric coming from Republican opponents of the law, who talk about their post-King plans as if transitioning from the current healthcare system will be a smooth process with no disruptions that will inevitably lead to a better system with more “freedom” and more “choice.” It’s a fantasy. The Republican plans for “transitioning” away from the ACA are disruptive and at war with themselves, and even if the party can overcome its internal dissensions and unite around a plan, it will invariably result in fewer people having less comprehensive health coverage than people currently enjoy under Obamacare. That’s the reality Obama sought to remind us of in yesterday’s speech.
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