Health Coverage for America: Signed, Sealed, and Delivered by the 2012 Election

The century-long struggle to establish a national health insurance system ended on November 8, 2012, when Speaker of the House John Boehner (R-OH) told ABC News reporter Diane Sawyer on a live national television interview that "Obamacare is the law of the land," and there would be no more attempts by the House to repeal the Patient Protection and Affordable Care Act (P.L. 111-148) (PPACA). Republicans opposed the bill from the start and fell just one Senate vote short in their attempt to defeat it. Anger about the new law contributed to the Republicans' victory in the 2010 midterm elections, in which they won 63 House seas and regained the majority they lost to the Democrats in 2006. After President Obama signed PPACA into law in March 2010, the newly elected Republican majority in the House voted more than 30 times to repeal it, despite their knowledge that repeal would never pass the Democrat-controlled Senate. While the House majority was approving repeal bills, other opponents of the law sought relief through the judiciary. Multiple lawsuits were filed by state attorneys general alleging the law to be unconstitutional, and these suits appeared to be making some headway as lower courts split on the constitutionality of the "individual mandate" requiring nearly everyone to buy health insurance or pay a tax. The Supreme Court resolved the conflicting lower court decisions last June in yet another close vote when their five-to-four decision ruled against the 26 state attorneys general. Only after the reelection of President Obama, buttressed by Democratic gains in both chambers of Congress, did the Republican leadership finally throw in the towel. Opposition to PPACA stands on reasonably firm political ground when you examine the lukewarm popular support for the law. The Kaiser Family Foundation conducted 32 monthly polls between March 2010 and November 2012 that showed the country to be consistently divided on the issue. The percentage of the population holding a favorable opinion of the law ranged between 34 percent and 50 percent, whereas those holding unfavorable opinions had a nearly identical monthly range of 35 percent to 51 percent. In 23 of the 32 months, the unfavorables outnumbered the favorables (Kaiser Family Foundation, 2012c). Some argue that these polls do not really reflect PPACA's popular support. They point to other Kaiser surveys that have found broad endorsement for nearly all of the law's individual components when these were presented to survey respondents independently and not tied to PPACA (Kaiser Family Foundation, 2012a). Others note that some of the unfavorable opinions came from respondents who wanted the law to go further, but the larger truth is that the overwhelming political support enjoyed by programs like Medicare and Social Security has yet to materialize for PPACA. Deep-seated American ambivalence toward universal health coverage is 100 years old. In 1912, Teddy Roosevelt and his Progressive ("Bull Moose") party first proposed universal health care to the national electorate. With support of Jane Addams, who gave a seconding speech for Roosevelt's nomination, and some large corporations like U.S. Steel, Roosevelt's campaign was more successful than that of any other third-party candidate in U.S. history, garnering far more popular and electoral votes than the incumbent president, William Howard Taft, a Republican. However, Roosevelt lost this White House bid to Woodrow Wilson, a Democrat, and a credible call for national health insurance did not reemerge until the New Deal. Franklin Roosevelt initially included national health care in his Social Security legislation. However, he jettisoned that component of the bill when he deemed it politically unpalatable and a threat to enactment of his old age and unemployment insurance proposals (Physicians for a National Health Program, 2012). Attempts to enact national health insurance were revived under Harry Truman's Fair Deal after his election in 1948, when several of our European allies were creating national health care systems. …