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What 'The Obamas' reveals about health reform

Five new details about the White House fight on ACA

Topics: Health Policy, Market Trends, Strategy

January 16, 2012

Dan Diamond, Managing Editor 

They're the most dissected First Couple in a generation.

It was the most scrutinized legislative battle in decades.

Is there anything left to learn about the Obamas and the health reform law?

According to a new book—yes.

'The Obamas' goes inside personal relationships, political alliances
Reported by New York Times White House correspondent Jodi Kantor, "The Obamas" captures the first 30 months of the Obama presidency by focusing on the dynamic between Barack and Michelle.  

The Affordable Care Act runs through Kantor's narrative—the health battle illustrating differences between the president and first lady, and the political price that Barack Obama paid to pass the ACA framing the book's later chapters.

And Kantor's reporting surfaces new insights and reinforces existing theories about the White House approach to health reform. (The White House has publicly challenged some of Kantor's assertions.)

Here are five takeaways about health reform as captured in "The Obamas."

1. The ACA pitted Chief of Staff Rahm Emanuel against Michelle
Based on his service in the Clinton White House, Emanuel argued that only incremental health reforms would succeed and that attempting a major overhaul like President Clinton's failed bill would doom Obama's presidency.

Meanwhile, Michelle had been long wary of her husband's run for the White House, anxious about the impact on her family and skeptical of the nation's political system. To the first lady, the personal sacrifices to achieve Barack's presidency would only be worth legislation on the scale of the ACA.

It was an ideological clash that divided the president's political and life partners. His spouse ultimately won.

2. Michelle was the biggest cheerleader for the ACA
Facing political attacks and drooping poll numbers throughout 2009, White House officials repeatedly urged Barack to change course on health reform. The administration was unprepared for the anti-ACA backlash, Kantor writes, and many felt that the legislative effort was poorly timed.

However, after advisors headed home and their children had gone to bed, the Obamas would sit on the White House balcony and discuss the policy battle. In these conversations, Michelle would remind her husband of health reform's moral imperatives and their shared goal to accomplish lasting change.

This was "Michelle's most profound influence on the Obama presidency," Kantor writes.

3. Barack's pragmatic approach wasn't shared by Michelle 
To pass the ACA, Barack was willing to trade off on high-minded goals—sacrificing his campaign pledge to close the Guatanamo prison or striking a deal with the pharmaceutical industry, for example.

But the president's deals "were diminishing his reputation as a reformer" across 2009 and into 2010, Kantor writes. Like many Democrats who had supported her husband, Michelle was anxious that Barack was becoming "just another politician," especially if the floundering ACA was to run aground. She further worried that the president's advisors had lost the pulse of the nation.

4. Scott Brown's victory both devastated and empowered Michelle
Michelle's fears were realized when Republican Scott Brown unexpectedly won Sen. Ted Kennedy's Senate seat in Massachusetts in January 2010—a staggering political upset that left the White House stunned and Barack's health reform effort on life support.

But the loss was also "grim evidence" for Michelle, who felt validated in her concerns about White House strategy. The first lady had spent months criticizing senior advisors like David Axelrod and Emanuel: the men "were not careful planners who looked out for worst-case scenarios," Kantor writes.

Both Axelrod and Emanuel would be gone from the White House within a year.

5. Emanuel nearly quit before the ACA succeeded
In the wake of Brown's victory, Barack's stalled agenda, and painful midterm elections looming, Emanuel began to leak his own disagreements with the president. One Washington Post column caused particular consternation.

As the stories emerged, Emanuel went to the president in February 2010 and offered to resign. "I'm not accepting it," Barack reportedly told Emanuel. "Your punishment is to stay here and get this bill done," pushing the chief of staff to work "tirelessly" on shorting up support.

The ACA passed a month later.

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