The Year In Health Care: A Topsy-Turvy Ride From its dramatic passage to efforts to repeal it or have it declared unconstitutional, the most sweeping change to federal health law in more than 40 years roiled the nation's politics in 2010. It promises to continue to do so into 2011.
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The Year In Health Care Policy: A Topsy-Turvy Ride

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The Year In Health Care Policy: A Topsy-Turvy Ride

The Year In Health Care Policy: A Topsy-Turvy Ride

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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This is MORNING EDITION, from NPR News. I'm Linda Wertheimer.


And I'm Renee Montagne. Good morning.

We're looking back this week at some of the most important developments of 2010. This morning, we're going to consider the new health-care law. It's become part of the economic debate; it played a role in this year's elections; and now, it's a source of lawsuits.

NPR's Julie Rovner takes a look back and a peek ahead.

JULIE ROVNER: 2010 began with everything going according to plan with the health bill. It had passed the House and Senate late the year before - the Senate on Christmas Eve, in fact. The president and Democratic lawmakers would work out a compromise; it would be approved by both houses, and it would become law.

It was all going according to plan until January 20th. That's when a little-known Republican state senator named Scott Brown scored an upset victory in the special election to fill the remaining term of the late Massachusetts Senator Ted Kennedy. Ironically, Brown had surged in the polls in large part by blasting the health bill.

Senator SCOTT BROWN (Republican, Massachusetts): It will raise taxes; it will hurt Medicare; it will destroy jobs and run our nation deeper into debt.

ROVNER: The most immediate impact of Brown's victory was that it deprived Democrats of their 60th Senate vote - the supermajority they needed to guarantee passage of the health bill without a Republican filibuster.

Professor THEDA SKOCPOL (Co-author, "Health Care Reform and American Politics: What Everyone Needs to Know"): And it looked like the end for health-care reform, at least briefly.

ROVNER: Theda Skocpol is a Harvard government and sociology professor, and a longtime historian of congressional health-care efforts. She says for a while, the entire effort seemed a bit frozen in place.

Prof. SKOCPOL: At first, it looked as if the White House was uncertain what it wanted to do, and there were all these people saying maybe we should pull back to something smaller - which wasn't really feasible after 15 months of intense negotiations about this large bill.

ROVNER: Eventually, however, Democrats realized they were so far into the effort, they basically had no choice but to push ahead. And overcoming last-minute controversies and exploiting every procedural rule they could, they were able to get the bill passed, and to President Obama's desk, by the end of March.

President BARACK OBAMA: Today, after all the votes have been tallied, health insurance reform becomes law in the United States of America.

(Soundbite of applause) (Soundbite of cheering)

ROVNER: But that was hardly the end. In fact, it was hardly the end of the beginning. Even as President Obama and Democrats were celebrating, Republicans around the country were filing the first of what would ultimately become more than 20 lawsuits against the measure.

Ken Cuccinelli is Virginia's attorney general.

Mr. KEN CUCCINELLI (Attorney General, Virginia): I've said all along that this lawsuit is not essentially about health care; it is about liberty.

ROVNER: That's because the lawsuits all claim that a key provision of the measure is unconstitutional; it's the one that requires nearly every American to have health insurance, or pay a penalty, starting in 2014.

But while the lawsuits started their slow slog through the judicial system, Republicans in Congress - and those running for election to Congress - launched a concerted effort to demonize the measure. Here's part of an ad from Rand Paul, a doctor and Tea Party favorite and now, Republican senator-elect from Kentucky.

(Soundbite of Rand Paul ad)

Unidentified Announcer: Rand always puts patients first. That's why he opposes the Obama-Pelosi health-care scheme, which puts Washington bureaucrats in charge, destroying the doctor-patient relationship...

ROVNER: By Election Day, Republicans retook the House and gained six seats in the Senate. And they vowed to make undoing the health law the centerpiece of their agenda.

For now, public opinion has not - as Democrats predicted - taken a big bounce upward as the new benefits began to take effect during the fall. But neither has it taken a big nosedive, despite the barrage of negative advertising.

Drew Altman is president of the nonpartisan Kaiser Family Foundation. It's been conducting monthly polling on the public's view of the health law.

Mr. DREW ALTMAN (President, Kaiser Family Foundation): Actually, if you look back, the public was split. And this was a divisive issue before the legislation passed; it was split during the legislative debate; and it remains split today. And it has been divided on pretty traditional partisan and ideological grounds.

ROVNER: Interestingly, though, polls show that while support for the law overall is weak, support for many of its specific provisions, even among Republicans, is quite strong.

Sociologist Skocpol says there's a longstanding academic explanation for that.

Prof. SKOCPOL: Americans are ideological conservatives but operational liberals. That's been an established principal in political science, and the study of American public opinion, for 50 years.

ROVNER: She says that means if you ask people if they prefer the government or the market to tell individuals what to do, they will always give the more conservative answer.

Prof. SKOCPOL: But if you ask Americans specific things: Do you want aid for the poor to buy affordable health insurance? Do you want tax credits for small business to help them insure their employees? They will always give the more liberal answer.

ROVNER: Meanwhile, Skocpol says she thinks that Republican vows aside, it will be very difficult to make the new health law go away.

Ms. SKOCPOL: Now, that's not to say that there can't be all kinds of mischief and delay in carrying through the intended combination of cost, controls and expanded coverage.

ROVNER: Meaning that the new Republican House next year will hold lots more hearings, and take lots of votes, to try to un-fund parts of the law. And more judges may declare the individual insurance requirement in the bill unconstitutional. But experts say the more new benefits the law - become entrenched, the harder they will be to take back.

Julie Rovner, NPR News, Washington.

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