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On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into law, providing every American with the opportunity to have guaranteed health care coverage. The Affordable Care Act-frequently referred to as Obamacare-is almost synonymous with Obama's presidential legacy and reflects a series of key decisions that he made beginning before he took office. As Meena Bose shows, it was Obama's particular brand of pragmatic politics that ultimately shaped the passage of the Affordable Care Act and made a lasting mark on health care reform in the United States. Pragmatic Vision examines eight of Obama's decisions that resulted in the landmark enactment of health care reform, starting with his commitment to health care reform in the 2008 presidential campaign and concluding with his decision to allow for flexibility with its implementation, following technical hurdles and Supreme Court rulings. Bose shows that Obama's steadfast commitment to the issue was crucial to its passing, especially after the Democrats lost their filibuster-proof majority in the Senate. Obama's direct engagement built key political support for the legislation and was aided by the senior White House staff and Democratic leaders in Congress who skillfully navigated the bill to passage just fourteen months after Obama took office. The story of Obama's leadership in enacting the Affordable Care Act is a tale of today's partisan divide and the polarization of Congress. The legislation passed on a party-line vote and continued to divide politicians long after its passage. Nevertheless, despite repeated efforts by Republicans to repeal the law, it is more popular today than ever and seems destined to remain in force until the next stage of reform. Pragmatic Vision is an authoritative guide to this singular achievement of the Obama administration.

After Hillary Clinton's stunning loss to Barack Obama for the Democratic presidential nomination in 2008, her decision to run again in 2016 appeared to mark another crossroads election, especially with the Republican presidential nomination of Donald Trump. Someone asked me recently if this is the most important presidential election in recent American politics, and I have been thinking about that question. Since it is happening during a global pandemic, the 2020 election certainly is comparable to other presidential elections in times of international conflict or economic turmoil. POLLING AND THE 2020 PRESIDENTIAL RACE As we look at public opinion polls about the presidential race, keep in mind that they are being updated frequently as the election nears. Public Policy. and International Affairs and the Peter S. Kalikow Center for the Study of the American Presidency will conduct the Kalikow School Poll twice a year and three times during presidential election years.4 This is a national poll administered by the survey firm YouGov. in which we oversample suburban likely voters. as their attitudes are of high interest given the importance of suburban voters in the 2016 and 2018 elections and our location in suburban Long Island.

One of President Barack Obama’s most significant and enduring policy decisions is signing into law the Patient Protection and Affordable Care Act (ACA) on 23 March 2010. For the first time, the federal government provided every American with the opportunity to obtain guaranteed health care coverage through a system of health insurance exchanges and subsidies to assist with insurance premiums. By expanding the social safety net to include health care, the ACA aimed to ensure that people would not suffer the physical or economic costs of illness by alleviating the burden of finding financially feasible medical care. But the legislative

Barack Obama’s road to the White House included a vast array of personal, academic, professional, and policy experiences, many of which diverged from those of his recent predecessors. After spending his childhood in Hawaii and Indonesia, Obama completed his undergraduate education in the United States and worked in community organizing before attending law school. He entered state politics in Illinois in the mid-1990s and launched a successful US Senate campaign in 2004, gaining national attention that year with a memorable keynote address at the Democratic National Convention. Less than three years later, Obama announced his candidacy for president, which surprised

President Obama’s leadership was essential for achieving health care reform in 2010. Without his steadfast commitment to the issue, particularly after Democrats unexpectedly lost their filibuster-proof majority in the Senate, the Affordable Care Act almost certainly would not have been enacted that year. In addition to Obama’s direct engagement in building political support for the legislation, senior White House staff and Democratic leaders in Congress skillfully orchestrated the bill’s passage just fourteen months after Obama took office. Despite Obama’s success, controversies continued over the legislative process, key provisions of the ACA, and its implementation. The partisan divide over the merits

President Obama’s focus on health care reform was grounded in decades of US policy planning, accomplishments, and disappointments. The United States developed national social welfare programs much later than other industrialized democracies for multiple reasons, including the founding principles of limited government and federalism. Still, by the early twentieth century, increased life expectancy and advances in medical technology created opportunities for hospital and physician care that extended far beyond the treatment of fatal illnesses.¹ As a result, health insurance plans were developed, particularly for workers who were insured through businesses and labor unions. This chapter presents an overview of the

After signing the ACA into law, Obama faced a complex implementation process. Some provisions of the law were instituted quickly, such as requiring insurance companies to provide access to some preventive health care services without cost. Larger components, such as the creation of a marketplace where people could compare health insurance plans before purchasing one, were scheduled to begin a few years later, given their complexity. Along the way, the ACA faced and survived challenges from multiple states that questioned its constitutionality, particularly the health insurance mandate. Despite many obstacles and complications related to implementation, the ACA’s enduring features were

At the start of 2010, Obama’s prospects for enacting health care reform seemed promising. In November and December 2009, respectively, the House and Senate had passed separate bills that would require significant negotiations to create consensus legislation. Still, the passage of legislation in each chamber, albeit almost entirely on party-line votes, indicated the possibility of a compromise bill reaching the White House. But that possibility suffered a major setback in mid-January when Democrats lost their sixty-vote majority in the Senate due to a surprise Republican victory in the special election to fill the seat held by the late Senator Ted

Upon taking office in January 2009, Obama confronted the worst US financial crisis since the Great Depression. In the first few months of his presidency, he oversaw passage of an economic stimulus package and a bailout of the automobile industry through loan guarantees to help the nation regain its financial footing. With such pressing priorities, health care reform risked being postponed until the economic situation stabilized. But Obama was determined to press forward, and he had a more favorable policy environment for doing so than Clinton, the last Democratic president to attempt a comprehensive overhaul of health care, did in