Two months ago, in my editorial detailing the positive legacy President Obama will leave behind at the end of his first term, I deliberately avoided mentioning his health care reform bill, given that it was at that time "on the Supreme Court chopping block." Now that it has been officially deemed constitutional, I think it is important to note the two-fold impact it will have on Obama's historical reputation:
1. It will forever associate Obama's name with the cause of health care reform. While most people take this for granted today, it is worth remembering that this issue was not at the top of the American policy agenda when Obama took office. The general public was focused primarily on the spiraling economic crash (which Obama has addressed much better than his critics are willing to admit) and, to a lesser extent, on the war on terror (especially Iraq), with the rest fracturing into small minorities when it came to the premium they placed on other major policy questions. Although Obama had mentioned his health care proposals often during his 2008 campaign, there was no reason to believe that he would necessarily prioritize that issue over the numerous others he broached once he actually took office. He wasn't facing any particularly acute circumstantial or political pressure to act on it, as he was with the economic crisis or the Iraq War.
Yet act on it he did. By aggressively pursuing a meaningful health care reform bill, Obama put that question at the forefront of American political discourse for much of his first term, spending the bulk of his post-election political capital on pushing the necessary legislation through Congress. While the health care reform issue obviously preceded Obama's presidency by decades, it was his effective use of executive initiative that brought about the results which have just been cemented today. Consequently, just as Theodore Roosevelt's name will be forever associated with opposition to monopolies and trusts and John Kennedy's with putting a man on the moon - not because these were the only things those presidents accomplished, mind you, but because they spent such great energy and political resources on bringing about results on those issues - so too will Barack Obama's brand be permanently linked in the history books with the cause of health care reform.
2. It will be remembered as strong policy. The Patient Protection and Affordable Care Act will
expand coverage to more than 30 million Americans by means such as expanding Medicaid eligibility to include individuals with incomes up to 133% of the poverty level, offering federal subsidies to individuals and families ineligible for Medicare and up to 400% of the federal poverty level, and creating health insurance exchanges in each state to provide health consumers with a more comprehensive range of coverage options. At the same time, it will end many of the unjust policies commonly practiced by insurance companies, such as discriminating against people with preexisting conditions, offering different premiums to clients based on age and geographic location, or placing annual and lifetime coverage caps. Finally, it will increase medical research funding and expand the National Institutes of Health, thus not only improving the quality of life for the American people but helping our nation maintain its edge as a world leader in medical innovation.
Just as important as the soundness of this policy, however, is the fact that it will be remembered as constitutional. For years, conservatives have tried to reverse the increasingly progressive rulings of higher courts, arguing that the liberal policies they support go against the intent of the Founding Fathers and our larger freedoms (I address the historical fallacy underlying many of their arguments in this editorial). While they have succeeded in doing this on many issues (see Citizens United v. Federal Election Commission), they had not taken down the signature legislative achievements of a progressive president since the days of the Four Horsemen during the New Deal era. Their determination to do this reached a peak when Obama passed his health care reform bill, reaching such irrational heights that they even pinned their hopes on invalidating a clause, the individual mandate, that had been first proposed by their own conservative thinkers (including Newt Gingrich and the Heritage Foundation). Their failure to succeed here doesn't mean that they will never manage to win the battle and take us back to pre-New Deal days; it does, however, constitute a significant setback, one that will be made much greater if Obama is reelected and one or more conservative judges wind up leaving the court.
Of course, health care reform hardly constitutes the end-all of Obama's larger historical legacy. He will also be remembered for preventing the Great Recession from becoming a second Great Depression, ending the war in Iraq, making the tough decisions that led to the assassination of Osama bin laden, repairing relations with nations that had grown alienated from America due to Bush's foreign policies, repealing Don't Ask Don't Tell, passing the Lilly Ledbetter Fair Pay Act, implementing significant financial regulatory reforms, strengthening consumers rights, and providing relief for those hardest hit by the recession. That said, if nothing else, the Supreme Court's validation of the Patient Protection and Affordable Care Act will forever rebut the charge lovingly made by Obama haters that he "hasn't done anything." Here is change that we can not only believe in, but that has actually become a reality.