The secrets of 'The Obama Memos'

Documents reveal president's decisions on health care

Topics: Health Policy, Market Trends, Strategy

January 27, 2012

Dan Diamond, Managing Editor

An exposé in the New Yorker reveals some of President Obama's private decisions about the health reform law, attracting the attention of Republicans.

Drawing on hundreds of pages of previously secret White House memos, author Ryan Lizza writes that Obama "is canny and tough—but...not the president his most idealistic supporters thought they had elected."

Specifically, Lizza focuses on the president's complicated choices during the political fight over the Affordable Care Act, including:

  • The decision to pass health care via reconciliation: When Democrats were first drawing up their health care legislation in 2009, they weighed whether to include budget reconciliation instructions.

    Reconciliation would allow Senate Democrats to bypass a potential filibuster and pass their law via a simple majority, but Republicans—and even some Democrats, like Sen. Max Baucus—opposed including the measure. Critics said it would be perceived as extremely partisan.

    But Obama agreed to support reconciliation measures in an April 2009 White House memo—a decision that would prove pivotal nearly a year later, after Senate Democrats lost their filibuster-proof majority and needed reconciliation to get the ACA through the chamber.

  • Support for revising the ACA's budget impact: The president had "prided himself on 'honest budgeting'" when preparing his first budget in 2009 and submitted a large request to Congress that he thought reflected the true cost of government, Lizza writes.

    However, the approach was rejected and Obama was attacked by critics as a profligate spender. So the White House sought ways to better present their next budget, and Obama in December 2009 signed off on "fiddling with the way [the ACA] presented savings" in order to show billions of dollars in additional cost cuts.

  • His exploration of malpractice reform: According to Lizza, Obama went against Democrats' own wishes by asking his top health care advisors to consider medical malpractice reform. While the president in a July 2009 memo (see memo here) told his staff not to "do anything that weighs down the overall effort," he encouraged them to explore malpractice reforms if it would retain the American Medical Association's support for the bill.

Republican Rep. Paul Ryan gets some unexpected mention as well. Named House Budget Committee chair in 2010, Ryan eventually emerged as one of Obama's fiercest critics over the ACA and government spending. But in early 2009, Obama encouraged his staff to look at Ryan's ideas about fiscal discipline and "see if any ma[d]e sense" for the White House to use.

Republicans unhappy
The New Yorker article upset several House Republican leaders, who said they have spent months asking the White House for the same memos.

In a letter sent to the White House on Wednesday, four members of the House Energy and Commerce Committee expressed their anger that the documents were leaked for the New Yorker article, but could not be sent for their committee's review.

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