Ten years later, a look back at the Affordable Care Act

By Louise Bernard, Director, Museum of the Obama Presidential Center

As we see so many people step up during this uncertain time, it’s worth taking a minute to look back and reflect on the role ordinary people have always played in shaping the direction of this country.

Ten years ago today, President Obama signed the Affordable Care Act into law. The President has said that the night the Affordable Care Act passed meant more to him than the night he was elected. When you watch his remarks in this video, you can see why.

As we build the Obama Presidential Center Museum in Chicago, we’re not only looking to tell the story of the President and Mrs. Obama, but the story of the broader Obama presidency. The voices of people like Natoma Canfield are crucial to that story. And they also remind us that the story of a president doesn’t end on the last day of their term. As the Affordable Care Act demonstrates, the decisions made a decade ago continue to shape our world today.

Since joining the Obama Foundation, I’ve met several people on staff who played a role in passing and implementing the Affordable Care Act. Here are some of their reflections on that moment in history, and how it continues to inform our work at the Foundation.

"My assumption when we started working on what became the Affordable Care Act was that the process for passing it would basically look like a lot of brilliant people inside the White House coming together to try to figure out the policy and then negotiate with Congress. But as the strategy unfolded, I began to see how integral voices from outside the White House were in shaping that process. It was very important to the staffers writing and negotiating the law to get input from external experts, stakeholders, local and state elected leaders and every day citizens. As part of the White House Office of Public Engagement and Intergovernmental Affairs, a lot of my team’s job was to channel voices from communities, doctors, hospitals, entrepreneurs, and public health experts to those policy making discussions, either with senior White House aides or the President himself.

"Part of that was basic political organizing—to understand what people outside the White House wanted. But it was more than that. It was also about getting the policy right on the front end and to understand how this would affect people’s lives.

"Like a lot of people on the White House staff in the first term, I had worked on the President's 2008 campaign. As part of that experience, I had spent significant time with people across the country talking about healthcare. Often, I would remember those African American families in the early primary state of South Carolina who spoke to me about healthcare and how much the disparities in our system negatively impacted their lives. I myself had several people in my family who were living with chronic illnesses, such as diabetes. Across the country, there were too many people suffering but not going to the doctor, not getting checkups and screenings, solid preventive medicine—because of their lack of adequate health insurance. I thought about those families a lot when I was in the White House.

"My youngest son is autistic and through the process of working on health care reform, I began to connect with members of the special needs community. In connecting around autism, I would talk to mothers and fathers exhausted because they had to stay up all night either taking care of their children or working two or three jobs to be able to afford the care that would meet their basic needs. I thought about those parents all the time."

"The White House in some ways is the most powerful place on the planet, but it is also one of the most isolated places on the planet. And any president, as the person whose office is supposed to represent everyone, is also paradoxically shielded from people in a way no one else is. So every night the President would receive ten letters in his nightly briefing book (Opens in a new tab) and those letters—written by everyday people expressing their hopes, their fears, and everything in between—were one of the few outlets that allowed him to hear directly from people about how they were actually living their lives.

"The act of writing to a president is both an act of desperation and hope. I remember one woman who wrote in because she had lost her home in The Great Recession. She was living in a van in Idaho with her kids and had no idea how she was going to care for her healthcare needs. Reading something like that in that building, you got a sense of both the despair someone must have felt to write to the President for help, and the hope that someone in the White House would actually read it. And I think all of us, especially the President, felt a special responsibility to people like that. Those letters were real and tangible reminders of why we needed to do that work.

"To me, the story of the ACA’s passage is the story of so many people (Opens in a new tab) exercising their citizenship and power. That moment would not have occurred in Washington had it not been for thousands, upon thousands, upon thousands of people in cities and states—over the course of decades—organizing to move the ball forward in small incremental ways. In those 14 months we worked to pass the law, the individuals who would write the President and their Members of Congress (Opens in a new tab), illustrated just how much action was needed. They engaged in an act of citizenship to say, 'I have this problem—I need you to address it and understand what I am suffering through.'"

"In early 2013 I left the White House to join Enroll America, a non-profit organization dedicated to helping Americans enroll in health care insurance once the ACA exchanges opened in fall 2013. Because you can pass a law, you can make opportunities available to Americans, but if they don't know about it, they're not going to take advantage of it. So a lot of our work as a national organization was dedicated to understanding who was the trusted voice at the local level that an uninsured person might listen to in order for them to receive information about what health care options they could access.

"During the first few enrollment periods, you could look county-by-county at enrollment numbers. There was one county in North Carolina, Robeson County, that stood out because it had a very high rate of enrollment compared to others. So I went down and we did an event there with the local hospital and local faith organizations that were working to enroll people.

"Talking to those different community leaders that day, they all stressed the leadership that one local volunteer named Vanessa had shown in the enrollment effort. She was the one that was driving enrollment fairs and bringing together different community members and organizations. She ultimately was honored as a White House Champion of Change. (Opens in a new tab)

"And to me that was a powerful example of what happened in local communities across the country. There were people like Vanessa, who wanted to get involved and recognized the opportunity they had to connect organizations in their local community to resources. I think about people like her when I think about our mission at the Foundation. From a programming perspective, we talk a lot about, 'how do you empower individuals to create change in their own communities?'"

"The underlying work of the foundation begins with the notion that every single person—in this country and throughout the world—has a voice. That they have agency and they have power; and that their agency, voice and power is not just to be expressed by voting. That's the minimum. Their agency, voice and power is to be expressed by bringing people together who share a view, share an outlook, share a set of values, and then to understand their power collectively to move the ball forward.

"Part of that is empowering individuals to express their leadership. But core to our programs is also equipping the next generation of leaders to understand what is possible when they have power. And why the use of power for the common good isn't something to be cared for and reserved just for the sake of having it—it's for those moments where you can exercise it for the common good. The ACA is a great example of that."

"There are people who work with us here in Chicago on building the Obama Presidential Center and bringing the Foundation's work to this community, who would not be alive if it weren't for the Affordable Care Act. So in a very tangible way I see the impact of that law in my work today.

"In conversations I have with people in Chicago, I don't see anybody running around and celebrating the fact that they have to go to the doctor—I guess very few of us like to go to our doctor—but the way that health care is talked about is different than it was before President Obama’s time in office. The Affordable Care Act put a floor, a strengthened safety net, underneath a lot of families.

"The ACA is a reminder that people in power can come together to do big things for their community. There were so many people who made sacrifices to pass this—volunteers on the campaign, staff in the Administration, members of Congress who knew that they might lose their jobs because of the votes they took to give people access to healthcare. Right now—in a moment where many people are deciding to help each other, to support each other, and to protect one another in the midst of an evolving crisis—it’s important to be reminded of the impact that we can have.

"But I also hope that when future generations come to the Obama Presidential Center and hear the story of the ACA, they understand that it’s a story of change coming from the bottom-up. The Foundation is built around that belief—that change comes from the bottom up. And in the coming years, as we craft programs in the community and build the Obama Presidential Center, our plan is for the OPC campus to be a dynamic space that serves as a physical manifestation of that promise.

"But that promise won’t be fulfilled without the involvement of people in this community taking action to help make it happen. To me, it's the same story."

You can learn more about the Obama administration’s work on healthcare by clicking this link.