With legacy on the line, Obama touts health-care implementation - Washington Post

Transforming the nation’s health-care system stands as Barack Obama’s most crucial piece of unfinished business, with much of his presidential legacy riding on whether it is deemed to have succeeded or failed.

While other presidents have managed to overcome intense opposition to major new social initiatives, Obama faces a degree of difficulty with health care that has no historic parallel.

So there was a certain urgency in the speech that Obama gave Thursday, the morning after the Republican-led House voted for the 38th and 39th times to dismantle all or part of the Affordable Care Act.

“There are still a lot of folks — in this town, at least — who are rooting for this law to fail. Some of them seem to think this law is about me. It’s not,” he said.

The process of implementing the law promises to be “many orders of magnitude more complicated” than establishing such programs as Social Security and Medicare, said David Blumenthal, president of the Commonwealth Fund, an organization that produces research on health and public policy issues.

Blumenthal, the Obama administration’s former coordinator of health information technology, also wrote a book on how 20th century presidents dealt with health-care policy.

He noted that both Social Security and Medicare are national programs that basically consist of paying bills and making payments to those who are eligible.

The new health-care law seeks to establish new health-insurance marketplaces and transform how care is delivered, while giving states more leeway in determining how that will be done.

Obama must also implement the new law against a united opposition party that is determined to throw as many obstacles as it can in his path.

“Obamacare is a disaster,” Sen. Marco Rubio (R-Fla.) said in a speech on the Senate floor shortly after the president’s remarks. “Mr. President, the plan is already failing.”

Some Republican lawmakers, who routinely help their constituents with concerns about Social Security and Medicare, have even served notice that they do not plan to assist those who come to them for aid in navigating the new health-care system.

“All we can do is pass them back to the Obama administration. The ball’s in their court. They’re responsible for it,” Rep. Jason Chaffetz (R-Utah) told the Hill newspaper last month.

The question of who is to blame for the fact that the bill passed without a single Republican vote is likely to remain a matter of dispute between the parties for years to come.

If the president ever had any real hope that Republicans would embrace the new law after the Supreme Court upheld its constitutionality and he won reelection, he has since given that up.

But current and former administration officials say Obama and his team have been surprised at how steadfast the opposition has remained.

“It used to be that you had a fight, and it was over, and you moved on,” said Massachusetts Institute of Technology economist Jonathan Gruber, who consulted with the administration and congressional Democrats in putting together the law.