How The Affordable Health Care Act Began In Illinois

An excerpt from Ward Room blogger Edward McClelland's book Young Mr. Obama: Chicago and the Making of a Black President.

The Health and Human Services Committee, which Obama chaired during his last term in Springfield, was the most liberal body in the Senate, a popular assignment for blacks, Latinos, and big-city whites. It was the perfect platform for Obama to advance his cause of universal health care.

Two weeks after the 2002 elections, Obama phoned Jim Duffett, the executive director of the Campaign for Better Health Care. Duffett had spent over a decade fighting to expand health care in Illinois.

“You might know this or not,” Obama told him, “but I’m now going to be the chair of the Senate Health Committee. I’d like to sit down with you.”

The Campaign for Better Health Care had chapters in most of Illinois' cities: Rock Island, Bloomington, Peoria, Carbondale. Obama wanted to hold town hall meetings around the state, to build support for universal health care. Illinois had just elected a Democratic Senate, and its first Democratic governor in 26 years, so this was the moment.

“You guys have these local committees all around the state,” he told Duffett. “I want to go out there. I want to use this as a tool, as a chairman.”

Duffett pitched him on the Health Care Justice Act, a bill that would require the legislature to come up with a plan for covering the 1.4 million Illinoisans who still didn't have health insurance. Obama loved the idea. In the winter of 2003, they hit the road. To Obama, was this another community organizing project. On cold weeknights, dozens of people shuffled into libraries or union halls to hear Obama speak.

Obama described the Act, and then, hearkening back to his days as an organizer, he told the gatherings, “you have to put political pressure on these politicians and you've got to keep on pushing and pushing. If they say ‘no,’ don't give up. If they’re a Republican, and they don't support this thing, keep on putting pressure on them, because they go back to the district and they say, ‘Oh, my God, I'm really getting beat up on this issue. What's going on?’ Same thing with Democrats.”

Afterwards, Obama went out to dinner with the the local chapter's executive committee, telling its members “We need you as leaders for this movement.” That not only built support for the Health Care Justice Act, it built a network of union brass and liberal activists who would back Obama’s just-announced Senate campaign.

The insurance industry was adamantly opposed to the Act. Its lobbyists found the bill’s fatal flaw: it required the legislature to come up with a universal health care plan, which was unconstiutional. A General Assembly can’t dictate to a future General Assembly. Obama shelved the Act and brought it back in 2004, with less demanding language that “strongly urged” a plan to cover all Illinoisans, and created a task force to come up with a proposal.

Even the softened version was a tough sell. Conservative Democrats resisted. Denny Jacobs was an old friend of Obama’s, but he was an even older friend of the insurance companies. Obama lobbied hard in the cloakroom. He forced Duffett’s group to sit down with  insurance lobbyists and overcome their mutual loathing to craft language both groups could live with. Obama even changed the name of the panel from the Health Care Justice Task Force – which sounded like a left-wing pressure group – to the moderate Bipartisan Health Reform Commission.

Unlike his efforts to end racial profiling, or reform capital punishment, Obama did not win bipartisan support for the Health Care Justice Act. Republicans saw it as a back-door attempt to bring universal, single-payer coverage to Illinois. The bill contained no specifics, and the commission could only offer recommendations, but the GOP compared it to President Bill Clinton’s failed health care plan. During the final debate, Peter Roskam, the Republican spokesman on health care, led his party’s attack on the Senate floor.

“The Illinois Life Insurance Council is opposed,” Roskam argued. “The Illinois State Association of Health Underwriters is opposed, the National Federation of Independent Business is opposed, and the Illinois Chamber Employment Law Council is opposed. You know, this concept was one that Hillary Clinton took on in 1994 and it created such a stirring that there was a sea change, ultimately, in the politics of the United States. And it’s a bill that, while it is not as draconian as what the Clinton administration tried to do, which was basically a nationalization of health care; it is a bill that you’re being asked to consider today that has a lot of similar characteristics.”

Obama was taken aback and angered by the accusations, especially the suggestion that he was trying to push a single-payer plan on the state. Obama favored a single-payer plan -- he'd said so at an AFL-CIO forum in December 2003 -- but his bill left the details up to the task force, and the legislature. Although he never raised his voice -- shouting was not his style -- Obama defended his integrity passionately.

“The original bill on the House side, I think, would have legitimately raised some concerns with respect to some who might have been fearful that it was a mandate to introduce a single-payer plan,” he said. “I modified this. Insurance lobbyists here in Springfield have been engaging in such fear-mongering among its agents, suggesting that this was a single-payer bill, that, in fact, a lot of concerns were raised that had nothing to do with the bill that was before the body today.”

Obama, who was campaigning for the Senate by then, told of meeting a Galesburg man who was about to be laid off from the Maytag plant after 30 years. The man didn’t know how he could afford $4,500 a month for the drugs his son needed to stay alive after a liver transplant.

“The majority of people who do not have health insurance are not welfare recipients who are covered by Medicaid,” Obama said. “They’re folks who work every single day, doing their best to make ends meet and try to raise a family, and the single biggest cause of bankruptcy is when they get sick.”

All his bill would do, he argued, is say “let’s all sit down and try to figure out how to solve a problem.”

The Health Care Justice Act passed on a party line vote, 31-26, but it ultimately accomplished very little. It certainly didn’t bring universal health care to Illinois. After more than two years of meetings, the commission issued a report recommending a “hybrid” health care model that would require individuals to obtain coverage, either through their employers (who would have to provide health care) or by taking advantage of a state-funded subsidy. A minority of the members recommended a single-payer plan. The minority group included Dr. Quentin Young, who had supported Obama since his first run for the state senate. Young had always considered Obama a single-payer advocate, so he was disappointed that Obama had stripped the universal health-care requirement from the bill.

John Bouman, who had worked with Obama on poverty and health care legislation, was more forgiving. “I think he was in favor of universal, affordable, comprehensive care for all, and not necessarily a disciple of one means of doing it over another,” Bouman would say. “He’s ever the pragmatist, and single payer is ever the ideal. That’s his particular genius, and it causes him to take it in the neck from the left as well as the right.”

By the time the commission reported back to the legislature, Obama was gone to the U.S. Senate. Some of its recommendations were adopted by Governor Blagojevich, for a plan he called Illinois Covered. But Illinois Covered never passed. It became a casualty of Blagojevich’s inability to work with the legislature (as, eventually, did his entire governorship.)

During his last two years in the state senate, Obama did achieve some incremental expansions of health care. He passed a bill to lower the eligibilty for the Children’s Health Insurance Plan – AllKids – from 185 percent of the federal poverty level to 200 percent. The new rules added 20,000 children to the state-run health insurance program. Obama's bill also changed the threshold for low-income parents to 90 percent of the poverty level – double what it had been during the past two Republican administrations. That brought health care to 65,000 poor people and helped solve the problem of welfare recipients refusing jobs or raises because they were afraid of losing Medicaid.


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