The Obama Presidency and Health Insurance Reform: Assessing Continuity and Change

Abstract

During the 2008 federal campaign, Democratic presidential candidate Barack Obama placed comprehensive health care reform at the centre of his platform. In the light of the growing problems facing the US health care system, the time seemed ripe for another attempt to control health costs while expanding insurance coverage. Elected in the context of the deepest recession since World War II, President Obama nonetheless decided to reform the US health care system at the beginning of his presidency. Drawing on the historical institutionalist perspective, which stresses the effects of existing institutions and policy legacies on social policy development, this article analyzes health politics during the first fifteen months of the Obama administration before assessing the impact of the legislation enacted in March 2010. Although it does not radically break from the past, this legislation should bring about crucial changes to the US health care system.

Reassessing Policy Drift: Social Policy Change in the United States

“…Whereas Hacker's analysis pointed to ‘a formidable constellation of ideologically committed opponents and vested interests’ (Hacker : 254), the ‘problem pressure’ (Schmid et al . ) arising from the ongoing crises in the US health care system combined with an extraordinary set of institutional circumstances to enable President Obama and the Democratic Congress to enact the ACA (Béland and Waddan ; Jacobs and Skocpol ; Marmor and Oberlander ). This law constituted a formal revision designed at overhauling much of the US's fragmented health care arrangements.…”

WHY ARE THERE NO UNIVERSAL SOCIAL PROGRAMS IN THE UNITED STATES?: A Historical Institutionalist Comparison with Canada

“…Due to the institutional fragmentation of power in Washington and the high number of veto points in Congress, multiple compromises proved necessary to enact the PPACA, which weakened it. For instance, institutionally driven compromise led to the abandonment of the “public option” (an approach according to which the federal government would have competed directly against private insurers on the market) supported by the left of the Democratic Party but unable to muster sufficient support among Democrats in Congress (Béland and Waddan 2012a).…”

Recognising the face of the other: Difference, identity and community

“…The Berlusconi creation in Italy, the organisation called ‘People of Freedom’, is constituted not as a party but as a club, and the latest party phenomenon in Germany, the Pirate Party, is deliberately vague on its party programme and advocates instead a string of demands for open access to the Internet. Political controversies narrow down to the issue of the extent of control and regulation that the state is entitled to exercise, with the recent US controversy over President Obama's new scheme of health insurance being a prime example (Béland & Waddan, ).…”