Health Care Reform and American Politics: What Everyone Needs to Know PDF
Preview Health Care Reform and American Politics: What Everyone Needs to Know
HEALTH CARE REFORM AND AMERICAN POLITICS WHAT EVERYONE NEEDS TO KNOW® HEALTH CARE REFORM AND AMERICAN POLITICS WHAT EVERYONE NEEDS TO KNOW® 3rd EDITION LAWRENCE R. JACOBS AND THEDA SKOCPOL 3 3 O xford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America © Oxford University Press 2010, 2012, 2016 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form, and you must impose the same condition on any acquirer. Library of Congress Cataloging-in-Publication Data is available ISBN 978-0-19-026203-7 (hbk.) ISBN 978-0-19-026204-4 (pbk.) “What Everyone Needs to Know” is a registered trademark of Oxford University Press. 1 3 5 7 9 8 6 4 2 Printed in the United States of America on acid-free paper CONTENTS PREFACE AND ACKNOWLEDGMENTS vii INTRODUCTION: A TURNING POINT FOR U.S. HEALTH CARE AND POLITICS 1 TIMELINE OF HEALTH REFORM EVENTS 11 1 Why Now? Broken Health Care and an Opportunity for Change 17 2 The Year of Pitched Battles: Who Fought for What, Why, and How 50 3 How the Scott Brown Upset Strengthened Health Reform 101 4 What Did They Deliver? The Promise of Affordable Care 121 5 Will Health Reform Succeed? 149 GLOSSARY OF KEY PEOPLE, GROUPS, LEGISLATION, AND HEALTH CARE TERMS 191 NOTES 201 INDEX 219 PREFACE AND ACKNOWLEDGMENTS On March 23, 2010, President Barack Obama signed into law a landmark in U.S. social legislation, the Patient Protection and Affordable Care Act. In the two weeks before the critical vote on the fi rst day of spring, and especially in the hours before, the two authors of this book were e-mailing back and forth furiously. Would the President and House Speaker Nancy Pelosi manage to cobble together enough votes from House Democrats to pass comprehensive health reform? Would quar- rels over abortion derail the deal at the last minute? Which provisions—spelling out who would benefi t, and who would pay—would remain in the bill at the end? Our interest was intense not just because the outcome was uncertain until almost the last minute, but also because both of us, Larry Jacobs and Theda Skocpol, have been fascinated by the politics of health care reform for many years. We have writ- ten about past battles—for Medicare, for Clinton’s failed Health Security reform—and we have thought about what successes and failures in social-policy battles mean for American politics. Even before Obama’s White House signaled in early 2009 that it would proceed with a gargantuan effort to get Congress to pass comprehensive health reform amidst par- tisan polarization, the Great Recession, and intense special interest lobbying, the two of us had geared up to look at health care issues in the Obama presidency. After all, this was a viii Preface and Acknowledgments Democratic President who came to offi ce, along with large Democratic Congressional majorities, at a time when the U.S. health care system was clearly broken—facing skyrocketing costs and receding coverage of health care for middle-class and lower-income families. Obama and other Democrats had promised to act on much-needed reforms. Would they try to keep their promise, even after the economic crises intensifi ed and Republicans signaled total opposition? Would they suc- ceed, or fall short as so many would-be reformers before them had done? It was bound to be a fascinating political story that would tell us a lot about what is possible, and not, in U.S. politics in the early twenty-fi rst century. We were able to fi nish the fi rst edition of this book just a few months after President Obama’s signing ceremony, because we closely studied the process of health reform through all of its phases. From 2007 on, we tracked media coverage, public opinion, health-care trends, and statements by politicians and organized groups; during 2009 and early 2010, we went to Washington, DC, to interview key players in Congress and the White House. As we gathered real-time facts and perceptions, we could draw upon the best analyses in political science— about public opinion, about patterns of Congressional decision making and voting, about lobbyists and socvial movements, and about the effect of institutional rules and previous public policies on current debates. Our immersion in currently unfold- ing events, while armed with powerful social-science tools, put us in a position to analyze what was happening promptly. We moved equally quickly after the Supreme Court upheld Affordable Care on June 28, 2012. Our experience as historically and institutionally oriented political scientists also enables us to think about what comes next in health reform after the laws are on the books and affi rmed by the Supreme Court, as administrators, politicians, and interest groups struggle about how to put them into effect or revise them. We have aimed to pinpoint the next struggles in health reform, to share our insights about unfolding Preface and Acknowledgments ix developments with fellow citizens and with students and observers who care about the future of health care reform. That is why we put in the effort to fi nish this book and get it into the public sphere by the early fall of 2010, before the fi rst national election after the enactment of Affordable Care. This new edition allows us to extend our analysis through the intense legal and electoral battles in 2012. Many have helped us get it done. David McBride at Oxford University Press saw the potential and supported our effort to move quickly, as did Alexandra Dauler. Invaluable and highly skilled research assistance was provided by Melanie Burns, Charles Gregory, and Patrick Carter at the University of Minnesota, and by Vanessa Williamson at Harvard University (who not only worked on several chapters but also prepared the time line and glossary for this book). Larry Jacobs appreci- ates support from the University of Minnesota, one of the country’s original land-grant public universities, and from the Hubert H. Humphrey School of Public Affairs. We are grateful to the Russell Sage Foundation and its President Eric Wanner for its support of a scholarly working group on “Obama’s Agenda and the Dynamics of U.S. Politics.” The two of us are coordinating this working group, and our research on health reform is, in part, supported by the Foundation’s grant. We benefi ted from discussions with other members of the group, each of whom is tracking a policy area of his or her own. We also want to acknowledge the support of the Robert Wood Johnson Foundation that allowed us to track health reform after its enactment in 2010. Finally, we thank our spouses, Julie Schumacher and Bill Skocpol. Bill, as he always does with Theda’s books, read through the fi nal manuscript and made suggestions to improve clarity. Both Julie and Bill put up with their partner spending almost all the time for weeks on the challenging and fascinating task of fi nishing this book. Lawrence Jacobs, St. Paul, Minnesota Theda Skocpol, Cambridge, Massachusetts
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