Obama signs health care reform bill

The bill is projected to extend health care to more than 30 million uninsured Americans.

President Barack Obama speaks about health care during a rally held September 12, 2009, at the Target Center.

Matt Mead

President Barack Obama speaks about health care during a rally held September 12, 2009, at the Target Center.

Mike Mullen

On Tuesday, President Barack Obama signed into law the first major reform of the United States health care system since the creation of Medicare and Medicaid 45 years earlier. The Patient Protection and Affordable Care Act survived months of tea party protests, town hall demonstrations and legislative wrangling before ObamaâÄôs signing ceremony. âÄúWe didnâÄôt give in to mistrust or to cynicism or to fear,âÄù Obama said at the signing. âÄúInstead, we proved that we are still a people capable of doing big things.âÄù The bill, which passed a House of Representatives vote on Sunday night, is projected to extend health care coverage to more than 30 million people and Medicaid to an additional 16 million. According to a Congressional Budget Office report, the estimated cost will total $940 billion over the next 10 years in subsidies for coverage of lower-income Americans. It is also projected to reduce the federal deficit by $130 billion. The new legislation outlaws insurance companiesâÄô denial of coverage to people with pre-existing conditions, and children will be allowed to stay on their parentsâÄô coverage plans until the age of 26. The bill does not mandate that businesses offer coverage to employees, but businesses with more than 50 employees would be fined for each individual not covered. A similar method will be used for individuals, forcing nearly all adult Americans to have health insurance or pay a fine. As it had during the entirety of its debate, the billâÄôs passage drew harsh language from politicians on both sides of the issue. Gov. Tim Pawlenty, appearing on Good Morning America on Tuesday morning, said this legislation was the wrong solution to the countryâÄôs health care problem. âÄúThe nation faces big challenges, and we do need to fix our health care system,âÄù Pawlenty said. âÄúBut [the Democrats have] taken it to this big, federalized, bureaucratic, government-run, kind of nanny-nation approach, and there were better ways to do it. They shouldâÄôve worked with us on those better ways.âÄù Rep. Keith Ellison, D-Minn., had hoped the legislation would include a single-payer system or âÄúat leastâÄù a public option, but he said the bill was the best result given the situation. âÄúWe couldâÄôve done a lot more; we couldâÄôve done a lot better,âÄù Ellison said. âÄúBut you know, given everything, it still is an amazing accomplishment.âÄù Sen. Amy Klobuchar, D-Minn., said she spent much of the legislative process worrying about the âÄúsomewhat boring but important, incredibly importantâÄù issue of cost reform, seeking to reward the quality of care a hospital provides, rather than the number of tests billed to its patients. Though the bill passed the House vote without a single Republican supporter, Klobuchar said its final form was shaped by early negotiations with Republicans. âÄúThere are still a lot of bipartisan ideas in this bill, even though itâÄôs not passed with bipartisan support,âÄù Klobuchar said. Like Ellison, Klobuchar felt that in some respects, the bill did not go far enough. âÄúI really see this as a beginning and not an end,âÄù Klobuchar said. âÄúThe bill is not perfect. There will have to be changes in the future.âÄù Legal challenges Pawlenty sent a letter to Attorney General Lori Swanson, urging her to review what he called an âÄúunprecedented federal mandate.âÄù âÄúIt appears Congress may be overstepping its bounds by forcing individuals or businesses to buy insurance,âÄù Pawlenty wrote. Ben Wogsland, a spokesman for Swanson, noted in an e-mail that most of the individual mandates would not go into effect until 2014 and said the attorney generalâÄôs office would now begin reviewing the 2,400-page bill. Pawlenty was joined in questioning the reformâÄôs constitutionality by 13 conservative state attorneys general, who filed suit in a Florida court before the ink on ObamaâÄôs signature was dry. Amy Monahan, a University of Minnesota law professor and expert on health law, said these legal challenges would come down to a statesâÄô rights issue. Monahan said the Supreme Court had ruled that health insurance implicates interstate commerce and is therefore subject to federal regulation. âÄúMost experts agree that it isnâÄôt an issue, that the federal government does have this power,âÄù Monahan said. âÄúTheyâÄôre not actually forcing you to buy insurance; theyâÄôre giving you a choice. You can either buy insurance or you can pay a penalty, so essentially itâÄôs a tax.âÄù Ellison was confident that PawlentyâÄôs appeal to Swanson would fall short. âÄúTell [Pawlenty] lots of luck with Lori Swanson over there,âÄù Ellison said. âÄúLori knows the abuses of insurance; Lori knows the pain Minnesotans go through. IâÄôve just got a feeling that [PawlentyâÄôs challenge] is just sour grapes. They lost, and they shouldâÄôve lost, and itâÄôs good that they lost, and thank goodness that they lost.âÄù Complicating issues Humphrey Institute of Public Affairs professor and policy expert Larry Jacobs traced the DemocratsâÄô success in passing health care back to the partyâÄôs election victories in the last two elective cycles. âÄúIn 2006 and 2008 there was a remarkable shift in the balance of power,âÄù Jacobs said. âÄúWeâÄôve really had this kind of almost tidal shift in Congress.âÄù Jacobs said the Obama administration, which includes veterans of President Bill ClintonâÄôs failed attempt at health care reform in the mid-âÄô90s, learned from ClintonâÄôs failure. By putting health care reform on the table early in ObamaâÄôs term, Jacobs said the Democrats avoided a potential clash with the 2010 elections. Even so, Jacobs said that as the debate process dragged on for months, some elements of the Obama administration considered abandoning the issue. Jacobs said the enthusiasm of Speaker of the House Nancy Pelosi, D-Calif., was vital in the final stages of the billâÄôs passage. âÄúI think Pelosi stands as kind of the hero, or the villain, depending on how you want to look at it,âÄù Jacobs said. Klobuchar said a number of complicating issues âÄî from historic snowfalls in the nationâÄôs capital during the critical voting period in December to the surprise election of Massachusetts Republican Scott Brown to the Senate seat once held by Ted Kennedy âÄî put the entire bill in jeopardy. âÄúIt was somewhat of a harder thing to get done than people think,âÄù Klobuchar said. Ellison said that a few weeks ago, health care reform became a personal issue for him. He got a letter in the mail from BlueCross BlueShield telling him that his son, who turned 22 on March 13, would be removed from EllisonâÄôs coverage after a 30-day grace period. With the passage of health care, Ellison said his son would soon be back on his plan. Ellison observed that not only would his son be covered under the plan, but so would the children of those who had protested the billâÄôs passage. âÄúAll those tea partiers, if they have a child whoâÄôs 21 years old, about to be 22, will be able to keep their child on their health insurance, which will be remarkably important to their family,âÄù Ellison said.