Barack Obama recalls his toughest fight as president: Obamacare

An enlightening excerpt from former President Barack Obama's forthcoming memoir, A Promised Land, published on Monday by The New Yorker, takes readers inside the long, epic, and personal political battle within the White House for the passage of the Affordable Care Act. Detailing the first year of his presidency, Obama offers an inside look into the arduous journey towards making Obamacare a reality and how it still manages to survive despite President Donald Trump's repeated threats of repealing and replacing it. The chapter comes at a crucial moment for his signature piece of legislation as the healthcare law faces a new threat from Amy Coney Barrett's ascent to the Supreme Court on Monday night.

"In the middle of a pandemic, this administration is trying to dismantle the Affordable Care Act in the Supreme Court," Obama said of the chapter release on Twitter. "Here's how Joe and I fought to expand healthcare, protect millions of Americans with preexisting conditions, and actually get it done." In the excerpt, the father-of-two opens up about the constant pushback he faced both from members of his own party and otherwise, including two of his top advisers—Rahm Emanuel and David Axelrod—who warned him of just how much it would cost him. "We all think we should try. You just need to know that, if we lose, your presidency will be badly weakened," Axelrod told him. "We better not lose, then," Obama replied.

Obama's efforts to reform the nation’s broken healthcare system did indeed cost him a great deal politically—eventually giving way to the rise of the Tea Party movement—but it was a cost he was willing to pay as he admits his interest in health care went beyond policy or politics. It was personal. "Each time I met a parent struggling to come up with the money to get treatment for a sick child, I thought back to the night Michelle and I had to take three-month-old Sasha to the emergency room for what turned out to be viral meningitis," Obama recalls in the upcoming first volume of his memoirs of his time in the White House.

"I remembered the terror and the helplessness we felt as the nurses whisked her away for a spinal tap, and the realization that we might never have caught the infection in time had the girls not had a regular pediatrician we felt comfortable calling in the middle of the night. Most of all, I thought about my mom, who had died in 1995, of uterine cancer," he reveals. The 59-year-old explains that while he entered the process of reimaging the country's healthcare system with overconfidence, he was nevertheless aware of how "mind-numbingly complicated" it would be.

"The question was whether we could get it done. Any major health-care bill meant rejiggering a sixth of the American economy. Legislation of this scope was guaranteed to involve hundreds of pages of endlessly fussed-over amendments and regulations. A single provision tucked inside the bill could translate to billions of dollars in gains or losses for some sector of the health-care industry. A shift in one number, a zero here or a decimal point there, could mean a million more families getting coverage—or not. Across the country, insurance companies were major employers, and local hospitals served as the economic anchor for many small towns and counties. People had good reasons—life-and-death reasons—to worry about how any change would affect them," he noted.

"There was also the question of how to pay for the changes. To cover more people, I argued, America didn’t need to spend more money on health care; we just needed to use that money more wisely. In theory, that was true. But one person’s waste and inefficiency was another person’s profit or convenience; spending on coverage would show up on the federal books much sooner than the savings from reform; and, unlike the insurance companies or Big Pharma, whose shareholders expected them to be on guard against any change that might cost them a dime, most of the potential beneficiaries of reform—the waitress, the family farmer, the independent contractor, the cancer survivor—didn’t have gaggles of well-paid and experienced lobbyists roaming the halls of Congress," Obama added.

Ultimately, the landmark legislation has proved remarkably durable against a decade of attacks on accord—at least in part—to its having been born in fire. While imperfect, Obamacare has yet to be undone by President Trump who has relied on his party's "repeal and replace" talking points for much of his presidential campaigns and time in office. We are yet to see the "beautiful" plan he's repeatedly claimed to have ready to take the existing legislation's place; a point his predecessor pointed out during a drive-in rally in Philadelphia last week. "We’re going to have a great replacement," Obama said at the rally. "It’s been coming in two weeks for the last 10 years. Where is it? Where is this great plan to replace Obamacare? They’ve had 10 years to do it. There is no plan."