In lieu of an abstract, here is a brief excerpt of the content:

115 chapter nine Federalism and the Affordable Care Act Beginning with President Franklin D. Roosevelt’s New Deal in the 1930s, Americans began to look to the federal government to remedy some of the country’s most pressing social, economic, and environmental ills. The Social Security Act of 1935 created federal pensions, unemployment insurance, and welfare assistance programs. In the 1960s, President Lyndon B. Johnson’s War on Poverty and other Great Society–era programs significantly expanded the role and reach of the federal government. Social Security was broadened, welfare assistance expanded, and Medicare and Medicaid were created. Strong environmental standards and regulations were passed, including the Clean Air Act and the Clean Water Act. Congress and the president enacted legislation governing the safety of food and drugs, the minimum wage, workplace conditions, and civil rights. However, all attempts to enact universal health care coverage were thwarted.1 Beginning in the 1980s, Ronald Reagan put the brakes on this progressive social welfare agenda. The “liberal” label became an insult, with severe ballotbox consequences for politicians. Not recognizing the magnitude of this seismic political shift, liberals clung to the belief that the federal government was the place to germinate progressive policy change. Democrats played defense, placing hopes in the next election and the emergence of a national political savior in the mold of FDR or LBJ. This strategy protected vital elements of the social safety net, including Social Security, Medicare, and Medicaid, but progressive social welfare policy at the national level was moribund. The election and governance of President Bill Clinton demonstrated how conservative principles still dominated the American political landscape in contemporary times. Clinton’s legislative agenda was actually to the right of that of President Richard Nixon, a Republican who two decades earlier had 09-2483-4 chap9.indd 115 6/25/13 5:32 PM 116 / federalism and the affordable care act advocated for the Family Assistance Program, which would have guaranteed a minimum income for all American families. Nixon instituted national wage and price controls on industry and enacted progressive environmental protection legislation. He also advocated for universal health care with a strong employer mandate to provide health insurance.2 President Clinton, similar to his predecessor President George H. W. Bush, wanted to be the education president and pushed for volunteerism (Bush had his “Thousand Points of Light” campaign and Clinton had Americorps ). Clinton advocated for free trade agreements and passed a welfare reform program that held recipients more accountable by including work requirements and time limits on receipt of benefits. While Ronald Reagan had said that “government isn’t the solution, it is the problem,” Bill Clinton announced that “the era of big government is over.” One major exception was Clinton’s health care proposal, which suffered a stunning defeat. Reducing poverty and advocating for national policies to expand opportunity to the most vulnerable remain a losing political issue in the United States. President Obama seeks to be the great reconciler-in-chief, bringing together the political left and right to address the nation’s economic crisis. And while the economic stimulus package included significant funding for infrastructure and enhanced funding for the states, the government’s bailout of the banks and support of Wall Street sustained to a large degree President George W. Bush’s policies. Despite his largely moderate record and agenda, President Obama is decried on the right as a “socialist.” Tea Party backers are convinced of it, progressives wish it were at least a little bit true, and Europeans and others with a broader view of the political spectrum find it all a bit comical. As was Clinton’s, the Obama administration’s notable progressive social policy initiative was national health care reform. I was a member of the Clinton health care task force—and admittedly part of the problem. The task force presented a fully delineated plan to Congress, leaving interest groups and some key Congressional leaders feeling alienated from the process.34 In the end, the only people who “owned” the Clinton plan were the Clintons. But this time, the outcome was different. The Obama administration learned from the defeat of the Clinton plan. First, Obama gave ownership of the process and details to Congress. When Congress creates detailed legislation , it engages interest groups more directly in the process. Although that risks discontinuity, multiplicity of purpose, complexity, and inefficiency, it increases the chance of passage. Second, the Obama administration negotiated directly with interest groups such as the insurance industry and...

Share