If former Massachusetts governor Mitt Romney and President Obama face off in the 2012 presidential campaign, America will witness the singular spectacle of two candidates getting very little love — and plenty of hate — for the same signature achievement: reforming health care.
Both overcame long odds to pass legislation, Romney in Massachusetts, Obama at the national level. Even the specifics of their reform laws are similar — both include subsidies for private insurance, the establishment of insurance exchanges and a mandate for individuals to maintain a minimum level of coverage. Each man expected to reap credit for his effort. But neither has gotten any political mileage out of it — in fact, both may have lost more ground than they picked up.
A look at how the law got to the Supreme Court and the issues in play
Why didn’t health-care reform pay off politically? In another era, we might be celebrating the remarkable fact that both a Democratic president and a leading Republican challenger arrived at fundamentally the same approach to fixing our health-care system. But that is not the America we live in now. Instead of rejoicing at how we’ve finally solved a national problem with a long and acrimonious history, we’re about to plunge into a new phase of that battle, with the Supreme Court agreeing to rule on the health law’s constitutionality in its new term — possibly at the height of a presidential campaign that could come down to the two men most tied to the issue.
In the abstract, many Americans say they want just the kind of moderate, constructive leadership that Romney and Obama exercised in passing health-care reform. But these days, moderate policies don’t necessarily make good politics. Romney’s biggest achievement has become his biggest burden in the GOP primaries because tea-drinking Republicans aren’t much interested in compromises. Likewise, on the left, many Democrats are disappointed that the 2010 Patient Protection and Affordable Care Act didn’t go far enough and, in particular, omitted a “public option” for insurance.
After watching Romney succeed in 2006 with a reform approach descended from a long line of moderate Republican proposals, Democrats gravitated to a similar middle-of-the-road effort that they thought could gain broad, bipartisan support. But in doing so, they made some key concessions to moderation that have proved especially damaging to popular support for national health-care reform. And it didn’t have to be that way.
Primarily to ensure that the Congressional Budget Office would “score” the legislation as reducing the deficit, Obama agreed to delay implementation of the major provisions of the law until January 2014, nearly four years after the bill passed. And contrary to his position during the 2008 campaign, the president also agreed to an individual mandate — again, partly to keep down the program’s cost — even though the mandate predictably became the law’s most unpopular provision and the focus of legal and political challenges.
These concessions have had opposite effects on the emotional commitments in the two parties. While opposition to the mandate has become a rallying point for Republicans, the long delay in implementing reforms has left many Democrats discouraged and uncertain about the law’s benefits. The four-year timetable also undercuts any possible political gain from the reforms; the president will have little to show by the 2012 election and little chance of clearing up the confusion and anxieties about the law.