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Part of the legacy of the ACA is that it is living. It was forged through shared values, community, relentless learning and adaptation, and a willingness to fight for health care as a right. So, rather than delve into the details of the ACA’s impact or historical timeline, we will look back to glean lessons for how we can move forward.
Obama: “Progress Is Possible”
Former President Obama began the conference through a video message. Remarking on history, he said:
It can feel like a different era sometimes, but fifteen years ago I signed the Affordable Care Act into law. The goal back then was to establish that here in America, health care is not just a privilege but a right for every single American.
President Obama described the results by the numbers: almost 50 million Americans have gained health coverage through the ACA and the number of uninsured has been cut nearly in half. He also explained what the law has meant to individuals and families, such as: “more sick kids getting medicine, more cancer patients having lifesaving surgery, more people with pre-existing conditions enjoying the peace of mind they deserve.”
President Obama turned to the present and purpose of the conference.
I’ve always said that the ACA is like a starter house. It was a big step forward but still just a first step. Now it is up to all of us to keep building on and improving the ACA until everyone has access to quality, affordable health coverage.
He discussed the need to “solve old problems and address new ones.” President Obama closed by saying:
But, if we learned anything fifteen years ago, it’s that even when the climb looks steep, and it certainly does right now, progress is possible. Regular folks can change this country for the better, and the more we can learn from the past, the better off we’ll be in the future.
Pelosi: “Opportunity of a Generation”
Speaker Emerita Nancy Pelosi, Congressional champion of the law, offered insight into the ACA’s passage, including the “atmospherics” the day the legislation passed in the House. Despite protests, yelling that could be heard in the Capitol that she described as “vicious,” she said, “It was such a joy. We thought we were joining the ranks of those who passed Social Security, Medicare, Medicaid.”
Moderator Karen Tumulty, associate editor and columnist at the Washington Post, asked Speaker Pelosi to describe getting the votes in the first place:
For 100 years, presidents had tried to bring health care reform into play, into the lives of the American people, from Teddy Roosevelt on, Franklin Roosevelt, Truman, LBJ with Medicare and Medicaid, and then the Clintons. But, when Barack Obama became president, it was clear, and we had the majority, that we had an opportunity of a generation and we were not going to let another hundred years go by before we passed affordable health care.
She discussed overcoming seemingly intractable issues like abortion (with allies and opponents in nuns and bishops); regional disparities in costs assuaged through late-night negotiations and a letter from U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius committing to action outside of the legislation; and leading the House to support the Senate bill. She described a different letter from “the saintly, remarkable, wonderful” Senate Majority Leader Harry Reid that had the signatures of fifty-one senators supporting changes to the Senate bill necessary for passage in the House. “He made it happen, Harry did.”
CAPTION: Speaker Emerita Nancy Pelosi speaks with associate editor and columnist at the Washington Post, Karen Tumulty.
One of the most memorable quotes from the fight to pass the ACA was Speaker Pelosi’s statement of her strategy in January 2010 after a special election made the prospects for health reform dim: “You go through the gate. If the gate’s closed, you go over the fence. If the fence is too high, we’ll pole vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people.“ At a press conference after passage, she said she was asked, “which one did you do?”
I said we did the first one: we pushed open the gate because it was not just the courage of my members who were there strongly and knew why they were there, to push open that gate to pass this bill. It was the outside mobilization, it was … all the groups that represented people with one diagnosis or another, it was people who just wanted health care.
The history of the ACA hardly ended with its passage. Speaker Pelosi said “one of the hardest jobs I had in leadership” was preventing repeals of parts of the law. She also discussed the repeal effort in 2017 led by President Trump and the Republican-led Congress: “The thumbs down heard round the world by John McCain really saved the Affordable Care Act but it was saveable because of this outside mobilization.”
Speaker Pelosi also drew from the ACA saga lessons for current debates. She discussed the potential cuts to Medicaid in the current Congress:
We can’t let it happen. It’s just too big a burden for individuals to pay and their families. If you know any people with a child born with other abilities, but not all of them, you would know how important Medicaid is to those children and how it makes a difference in how they can learn and grow and the rest.
Tumulty asked about members of Congress who voted for the bill, knowing that it would likely prevent their reelection in conservative districts, comparing it to current times. She said, “We came here to do a job, not keep a job.”
Looking Back: Insights from Officials on the Front Lines
Lambrew, who worked on the ACA at HHS in 2009 and 2010 and the White House from 2011 through 2016, moderated a discussion with the White House leader and the two secretaries of HHS during the Obama administration. It focused on lessons on leadership.
CAPTION: Jeanne Lambrew moderates a discussion with Kathleen Sebelius, Nancy-Ann DeParle, and Sylvia M. Burwell.
Nancy-Ann DeParle, managing partner and co-founder, Consonance Capital Partners and former director of White House Office of Health Reform, described the clear signal of the President Obama’s leadership and tone at the top, shared within the White House, by the House and Senate leaders, as well as powerful committee chairs willing to cede power that historically “just doesn’t happen.” This extended to staff who
were willing to put aside their own preferences, if they had to, not until the very last minute, but at the very last minute they were willing to do that to keep moving forward and to get it done. I don’t know what you call that: trust and leadership and unselfishness.
Kathleen Sebelius, CEO, Sebelius Resources LLC and twenty-first U.S. secretary of health and human services, agreed:
“It wasn’t this tiny little group working on health reform. Everybody worked on health reform. Everybody was in, everybody brought ideas and talents.…. This was an all hands on deck…. This was very clearly the president’s top priority, he was willing to put any amount of political capital on the table to get this done, and I think that was the inspirational driver.”
Sylvia M. Burwell, former president of American University and twenty-second U.S. secretary of health and human services, observed that the job of a secretary is “both leader and manager.”
It’s a high-wire act. Not just for those of us sitting here, but it’s for every team member. And so making sure that you are always there to have that team member’s back so that they know and they’re not afraid. They’re not afraid to be able to get out there, to try, and to jump, because there were many times when you were like you needed to jump for the bar and we were on a flying trapeze.
CAPTION: Kathleen Sebelius, Nancy-Ann DeParle, Sylvia M. Burwell, and Jeanne Lambrew smile for a picture at TCF event to Commemorate ACA’s 15th Anniversary.
These veterans discussed what they would have changed and what surprised them. This included the challenge of including the “individual mandate” or requirement that people who can afford health coverage buy it which was repealed in 2017 without a significant effect. They discussed attempts to make the law bipartisan and the challenges that resulted from provisions added in that attempt as well as the oversight that resulted because it lacked bipartisan support. Sebelius said her surprise was, in one word, the “website,” referring to the challenges in launching HealthCare.gov. DeParle discussed the inability to get sufficient funds for implementation.
They also fast-forwarded to the 2017 debate over repealing the ACA and efforts to mobilize and defend the law which, as Burwell described it, was part of the fabric of the system—the “thread had been woven.” Sebelius told the stories of strangers who have shared with her how the law helped them and their families. And DeParle spoke of how President Obama had wanted the law to be more generous from the start, lauded the progress made during the Biden administration to advance coverage, and how, looking forward, “there is no rest for the weary.”
Looking Forward: Thoughts from New Leaders
Sherry Glied, dean and professor of public service, Robert F. Wagner Graduate School of Public Service, New York University, led a discussion on what is next in major changes for our health system.
CAPTION: Sherry Glied moderates a discussion with Kody Kinsley, Anthony Wright, and Christen Linke Young.
Kody Kinsley, senior advisor at the Milken Institute and former North Carolina secretary of health and human services, explained:
When we see medical debt in this country as out of control and the leading cause of bankruptcy and we have our hospital systems and other providers stuck in these cycles where they are chasing dollars that they are never going to collect, one to three pennies on the dollar, it is exhausting, it’s a churn, and it’s clearly not working. So I think that revisiting cost sharing across all layers of plans is key.
Christen Linke Young, currently a visiting fellow at the Brookings Institution and former deputy assistant to the president at the White House, said: “Health reformers need a policy agenda that is focused on those points of friction in the system and how we can ease the way people experience those burdens.” She continued, “An agenda that tries to ease those pain points also needs to be serious about pairing them with meaningful reforms that drive down health care prices and lowers costs for people.”
Anthony Wright, executive director, Families USA, offered a reminder:
Let’s not lose the goal of coverage, of getting to universal coverage: it is so important, it is so foundational. And, there is so much to do to make coverage not just more accessible but more affordable, and, as Kody was saying, more administratively simple if not automatic. We should get to a world where, when everyone is eligible for something, to figure out how it all works together so it is seamless, so the burden of enrollment in these times of life transitions is on the system and not on the individual.
In Closing
CAPTION: Chiquita Brooks-LaSure, senior fellow, The Century Foundation and former administrator of the Centers for Medicare and Medicaid Services (CMS), gives closing remarks.
Chiquita Brooks-LaSure, senior fellow, The Century Foundation and former administrator of the Centers for Medicare and Medicaid Services (CMS), gave closing remarks. She included thanks:
Even though we are in this incredibly difficult moment where it feels like so many of the things that we have all worked for are under attack, we are in such a different place than we were, and a lot of that is because of all of the work of all of you….
And she ended with a note of optimism: “This is a moment to remember what happened because it has lessons for us for the future. In times of crisis, there is an opportunity.”
Preparing for the Opportunity
Lambrew concluded by saying, “Today, we turn from one chapter of the ACA to another. It is now the time to start developing new health reforms for a moment in the future when that window of opportunity may open again.”
Speaker Emerita Pelosi, President Obama Join Hundreds at TCF Event to Commemorate ACA 15th Anniversary
On March 25, The Century Foundation convened fifteen speakers, an in-person audience of nearly 200 people, and others via webcast at an event to mark the fifteenth anniversary of the signing of the Affordable Care Act (ACA). Its director of health care reform, Jeanne Lambrew, explained the conference’s purpose:
Part of the legacy of the ACA is that it is living. It was forged through shared values, community, relentless learning and adaptation, and a willingness to fight for health care as a right. So, rather than delve into the details of the ACA’s impact or historical timeline, we will look back to glean lessons for how we can move forward.
Obama: “Progress Is Possible”
Former President Obama began the conference through a video message. Remarking on history, he said:
It can feel like a different era sometimes, but fifteen years ago I signed the Affordable Care Act into law. The goal back then was to establish that here in America, health care is not just a privilege but a right for every single American.
President Obama described the results by the numbers: almost 50 million Americans have gained health coverage through the ACA and the number of uninsured has been cut nearly in half. He also explained what the law has meant to individuals and families, such as: “more sick kids getting medicine, more cancer patients having lifesaving surgery, more people with pre-existing conditions enjoying the peace of mind they deserve.”
President Obama turned to the present and purpose of the conference.
I’ve always said that the ACA is like a starter house. It was a big step forward but still just a first step. Now it is up to all of us to keep building on and improving the ACA until everyone has access to quality, affordable health coverage.
He discussed the need to “solve old problems and address new ones.” President Obama closed by saying:
But, if we learned anything fifteen years ago, it’s that even when the climb looks steep, and it certainly does right now, progress is possible. Regular folks can change this country for the better, and the more we can learn from the past, the better off we’ll be in the future.
Pelosi: “Opportunity of a Generation”
Speaker Emerita Nancy Pelosi, Congressional champion of the law, offered insight into the ACA’s passage, including the “atmospherics” the day the legislation passed in the House. Despite protests, yelling that could be heard in the Capitol that she described as “vicious,” she said, “It was such a joy. We thought we were joining the ranks of those who passed Social Security, Medicare, Medicaid.”
Moderator Karen Tumulty, associate editor and columnist at the Washington Post, asked Speaker Pelosi to describe getting the votes in the first place:
For 100 years, presidents had tried to bring health care reform into play, into the lives of the American people, from Teddy Roosevelt on, Franklin Roosevelt, Truman, LBJ with Medicare and Medicaid, and then the Clintons. But, when Barack Obama became president, it was clear, and we had the majority, that we had an opportunity of a generation and we were not going to let another hundred years go by before we passed affordable health care.
She discussed overcoming seemingly intractable issues like abortion (with allies and opponents in nuns and bishops); regional disparities in costs assuaged through late-night negotiations and a letter from U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius committing to action outside of the legislation; and leading the House to support the Senate bill. She described a different letter from “the saintly, remarkable, wonderful” Senate Majority Leader Harry Reid that had the signatures of fifty-one senators supporting changes to the Senate bill necessary for passage in the House. “He made it happen, Harry did.”
CAPTION: Speaker Emerita Nancy Pelosi speaks with associate editor and columnist at the Washington Post, Karen Tumulty.
One of the most memorable quotes from the fight to pass the ACA was Speaker Pelosi’s statement of her strategy in January 2010 after a special election made the prospects for health reform dim: “You go through the gate. If the gate’s closed, you go over the fence. If the fence is too high, we’ll pole vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people.“ At a press conference after passage, she said she was asked, “which one did you do?”
I said we did the first one: we pushed open the gate because it was not just the courage of my members who were there strongly and knew why they were there, to push open that gate to pass this bill. It was the outside mobilization, it was … all the groups that represented people with one diagnosis or another, it was people who just wanted health care.
The history of the ACA hardly ended with its passage. Speaker Pelosi said “one of the hardest jobs I had in leadership” was preventing repeals of parts of the law. She also discussed the repeal effort in 2017 led by President Trump and the Republican-led Congress: “The thumbs down heard round the world by John McCain really saved the Affordable Care Act but it was saveable because of this outside mobilization.”
Speaker Pelosi also drew from the ACA saga lessons for current debates. She discussed the potential cuts to Medicaid in the current Congress:
We can’t let it happen. It’s just too big a burden for individuals to pay and their families. If you know any people with a child born with other abilities, but not all of them, you would know how important Medicaid is to those children and how it makes a difference in how they can learn and grow and the rest.
Tumulty asked about members of Congress who voted for the bill, knowing that it would likely prevent their reelection in conservative districts, comparing it to current times. She said, “We came here to do a job, not keep a job.”
Looking Back: Insights from Officials on the Front Lines
Lambrew, who worked on the ACA at HHS in 2009 and 2010 and the White House from 2011 through 2016, moderated a discussion with the White House leader and the two secretaries of HHS during the Obama administration. It focused on lessons on leadership.
CAPTION: Jeanne Lambrew moderates a discussion with Kathleen Sebelius, Nancy-Ann DeParle, and Sylvia M. Burwell.
Nancy-Ann DeParle, managing partner and co-founder, Consonance Capital Partners and former director of White House Office of Health Reform, described the clear signal of the President Obama’s leadership and tone at the top, shared within the White House, by the House and Senate leaders, as well as powerful committee chairs willing to cede power that historically “just doesn’t happen.” This extended to staff who
were willing to put aside their own preferences, if they had to, not until the very last minute, but at the very last minute they were willing to do that to keep moving forward and to get it done. I don’t know what you call that: trust and leadership and unselfishness.
Kathleen Sebelius, CEO, Sebelius Resources LLC and twenty-first U.S. secretary of health and human services, agreed:
“It wasn’t this tiny little group working on health reform. Everybody worked on health reform. Everybody was in, everybody brought ideas and talents.…. This was an all hands on deck…. This was very clearly the president’s top priority, he was willing to put any amount of political capital on the table to get this done, and I think that was the inspirational driver.”
Sylvia M. Burwell, former president of American University and twenty-second U.S. secretary of health and human services, observed that the job of a secretary is “both leader and manager.”
It’s a high-wire act. Not just for those of us sitting here, but it’s for every team member. And so making sure that you are always there to have that team member’s back so that they know and they’re not afraid. They’re not afraid to be able to get out there, to try, and to jump, because there were many times when you were like you needed to jump for the bar and we were on a flying trapeze.
CAPTION: Kathleen Sebelius, Nancy-Ann DeParle, Sylvia M. Burwell, and Jeanne Lambrew smile for a picture at TCF event to Commemorate ACA’s 15th Anniversary.
These veterans discussed what they would have changed and what surprised them. This included the challenge of including the “individual mandate” or requirement that people who can afford health coverage buy it which was repealed in 2017 without a significant effect. They discussed attempts to make the law bipartisan and the challenges that resulted from provisions added in that attempt as well as the oversight that resulted because it lacked bipartisan support. Sebelius said her surprise was, in one word, the “website,” referring to the challenges in launching HealthCare.gov. DeParle discussed the inability to get sufficient funds for implementation.
They also fast-forwarded to the 2017 debate over repealing the ACA and efforts to mobilize and defend the law which, as Burwell described it, was part of the fabric of the system—the “thread had been woven.” Sebelius told the stories of strangers who have shared with her how the law helped them and their families. And DeParle spoke of how President Obama had wanted the law to be more generous from the start, lauded the progress made during the Biden administration to advance coverage, and how, looking forward, “there is no rest for the weary.”
Looking Forward: Thoughts from New Leaders
Sherry Glied, dean and professor of public service, Robert F. Wagner Graduate School of Public Service, New York University, led a discussion on what is next in major changes for our health system.
CAPTION: Sherry Glied moderates a discussion with Kody Kinsley, Anthony Wright, and Christen Linke Young.
Kody Kinsley, senior advisor at the Milken Institute and former North Carolina secretary of health and human services, explained:
When we see medical debt in this country as out of control and the leading cause of bankruptcy and we have our hospital systems and other providers stuck in these cycles where they are chasing dollars that they are never going to collect, one to three pennies on the dollar, it is exhausting, it’s a churn, and it’s clearly not working. So I think that revisiting cost sharing across all layers of plans is key.
Christen Linke Young, currently a visiting fellow at the Brookings Institution and former deputy assistant to the president at the White House, said: “Health reformers need a policy agenda that is focused on those points of friction in the system and how we can ease the way people experience those burdens.” She continued, “An agenda that tries to ease those pain points also needs to be serious about pairing them with meaningful reforms that drive down health care prices and lowers costs for people.”
Anthony Wright, executive director, Families USA, offered a reminder:
Let’s not lose the goal of coverage, of getting to universal coverage: it is so important, it is so foundational. And, there is so much to do to make coverage not just more accessible but more affordable, and, as Kody was saying, more administratively simple if not automatic. We should get to a world where, when everyone is eligible for something, to figure out how it all works together so it is seamless, so the burden of enrollment in these times of life transitions is on the system and not on the individual.
In Closing
CAPTION: Chiquita Brooks-LaSure, senior fellow, The Century Foundation and former administrator of the Centers for Medicare and Medicaid Services (CMS), gives closing remarks.
Chiquita Brooks-LaSure, senior fellow, The Century Foundation and former administrator of the Centers for Medicare and Medicaid Services (CMS), gave closing remarks. She included thanks:
Even though we are in this incredibly difficult moment where it feels like so many of the things that we have all worked for are under attack, we are in such a different place than we were, and a lot of that is because of all of the work of all of you….
And she ended with a note of optimism: “This is a moment to remember what happened because it has lessons for us for the future. In times of crisis, there is an opportunity.”
Preparing for the Opportunity
Lambrew concluded by saying, “Today, we turn from one chapter of the ACA to another. It is now the time to start developing new health reforms for a moment in the future when that window of opportunity may open again.”
For more information on TCF’s work on the future of health reform, visit TCF’s Health Reform Initiative or email [email protected].
Tags: affordable care act, health care affordability, aca