FINAL Thesis

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In America, being poor and uninsured can be a death sentence. The Patient Protection and Affordable Care Act (PPACA), President Obamas 2010 landmark healthcare legislation, sought to right that wrong. The road to the legislation was long and arduous, but the policy was signed into law much to the chagrin of Republicans throughout the country. The original version of the Act would allow Americans aged 19 to 64 to enroll in health insurance and not allow the lack of coverage to be an impediment to their lives or livelihoods. As anticipated, the Act faced partisan attacks and its constitutionality was challenged. In 2012, the Supreme Court upheld the constitutionality of the ACA, but they gutted the Act of the vital mandatory Medicaid expansion clause determining it to be unconstitutionally coercive of states. With the swipe of a pen, the Supreme Courts conservative led majority gave the power to the states to decide whether or not they would expand Medicaid and offer protection and coverage to their most vulnerable constituents. Many Republican led states elected not to expand or to develop Medicaid reform schemes to allow leadership to save face politically yet still provide services to their constituency. Indiana fell into the latter group and Governor Pence worked closely with aligned partners to develop HIP 2.0 which is marketed as Medicaid reform and not expansion under the ACA. Governor Pence continues to control the messaging and perception of the expansion as well as the healthcare destiny of Hoosiers. However, the intellectual dishonesty of the waiver program has been called out by liberals and conservatives alike. In this paper I will discuss the positive and negative impacts the hubris of Governor Pence has had on Hoosiers and make the case for why traditional Medicaid expansion would have been a better alternative both physically and fiscally for Indiana.Partisan PlotJanuary 20, 2009 is a day that will live forever in history. This is the day the first African American President of the United States of America, Barack Hussein Obama, was inaugurated. This was a momentous occasion, but also the day the fate of the country was laid at the feet of the Republican minority. Instead of embracing the new leadership and attending events to celebrate this historical event, Republicans instead met in a backroom of a Washington D.C. steakhouse to plot their return to power. All of the top power brokers in the Grand Old Party (GOP) were present. In his book, Do Not Ask What Good We Do: Inside the U.S. House of Representatives, Robert Draper describes the meeting and its intent in detail. There were approximately fifteen people present, inclusive of former Speakers of the House, Newt Gingrich and Eric Cantor and current Speaker of the House, Paul Ryan. Pete Sessions (TX), Jeb Hensarling (TX), Pete Hoekstra (MI), Kevin McCarthy (CA), Jim DeMint (SC), Jon Kyle (AZ), Tom Coburn (OK), John Ensign (NV) and Bob Corker (TN) were also in attendance. The dinner lasted for almost four hours and at the end of the dinner a plan had been devised to make Obama a one term president and to return the Republicans to power. Draper quotes Representative McCarthy (CA) as saying, If you act like youre the minority, youre going to stay in the minority. Weve gotta challenge them on every single bill and challenge them on every single campaign (Draper, 2012). The mood of the group when they left was not defeated as it was when they arrived, but instead they were giddy. Following that fateful night, the Republicans in the House and Senate put their plan into action. History reveals that they were able to take over majorities in the House and the Senate over the next 6 years, but were unable to take over the presidency. During this time, the 112th and 113th Congresses earned the dubious title as the least productive Congresses in history. While all legislation faced opposition during this time, there was none that faced or continues to face as much obstruction as the Presidents signature health care law, the Patient Protection and Affordable Care Act (PPACA). The Republicans plan to obstruct President Obama and the Democratic majoritys vision for the future was evident almost immediately. As such, President Obama and Democrats quickly came to realize that if they wanted to get anything of any significance passed during his first term, they would have to move quickly and decisively while they maintained the majority in the House and Senate. The Fight for Healthcare ReformThe issue of healthcare reform was one of President Obamas top domestic priorities. He knew this would be a tough battle and learned from the mistakes of his predecessors. Rather than having the executive craft the bill that would ultimately be introduced in Congress, as had been done in President Clintons failed effort more than fifteen years earlier, President Obama laid out the broad principles and goals that he wanted in a health care bill and left it to the House and Senate to provide the legislative details. Both chambers began working on healthcare in the early months of 2009, with the House taking the lead (Cannan, 2012).

The bill went through many modifications and in all fairness not only faced opposition by Republicans, but also fiscally conservative Blue Dog Democrats who feared the cost would be too much. The Senate was hard at work on their bill as well and by September 2009, legislation had been drafted by the House and Senate based on ideas that were cobbled together from past proposals that had been floated by Republican leadership and a multitude of drafts that had circulated various legislative committees. None of the ideas in the proposed legislation were new, in fact, the primary model that was utilized to draft the PPACA was Massachusetts health care program MassHealth. However, even though the bulk of the ideas were once publically held as good ideas in the past by Republicans and the legislation was modeled after a healthcare program from a Republican Governor, Mitt Romney, Republicans still refused to get behind the legislation. In addition to the multitude of committee meetings in both houses of Congress, President Obama also personally led joint meetings with Republicans and Democrats to elicit insight, feedback and gain common ground all to no avail. The GOP had no plan to reform healthcare, nor did they care. Their primary concern was blocking the legislation as per their plan that was devised that fateful evening on January 20, 2009. The lows the minority party in Congress would stoop to in order to block the legislation were especially on display the evening of September 9, 2009 when President Obama addressed a joint session of Congress and the American people about the proposed healthcare legislation. As President Obama stood at the podium in our most sacred vestige of democracy, he was called a liar. Joe Wilson, Representative for South Carolina interrupted the address and called President Obama, not once, but twice, a liar. The outburst occurred when President Obama stated, There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false-the reforms Im proposing would not apply to those who are here illegally (Obama, 2009). Never in recent history had such a breach in protocol and decorum been witnessed. The event received national and international coverage and reproach from both sides of the aisle. President Obamas challenger in the 2008 election, John McCain (R-AZ) stated of Wilsons outburst, No place for it in that setting or any other and he should apologize immediately (McClatchy, 2009). As evidenced by Mr. Wilsons half-hearted apology, the obstruction cloaked in a chorus of no, and the utter contempt and disregard for the President and his policies was on full view for Americans to see. One would think the American public could see through the partisanship of the fight but Republicans were deft at painting the legislation as a Federal takeover of healthcare that would rob people of choice, tax them unnecessarily, cause shortages and lest one forget subject our loved ones to death panels. The rhetoric was successful and ironically the legislation suffered an almost insurmountable blow when Senator Ted Kennedy (D-MA), a long time healthcare reform advocate, lost his battle with cancer and a special election was held for his seat. In spite of a fiercely contested battle the Republican candidate Scott Brown was elected. This was the first time a Republican had held this seat since 1952. Because of this development, the Senate did not have the necessary votes to resist a filibuster and the healthcare legislation was literally on life support. A different tactic would have to be taken to get the legislation passed. Democratic congressional leaders and White House officials met in what one article described as a substitute for a Congressional conference committee to draft a proposal that could pass both houses. The negotiations were held behind closed doors, which raised transparency concerns and meant that this important stage would leave no record aside from what was reported in the press (Cannan, 2012).

Democratic Congressional leaders and the President had invested too much time, effort and political clout to give up on healthcare reform so they turned away from traditional voting practices and moved the legislation through a process known as reconciliation. This was not a popular move and Republicans were outraged. However, as Senator Judd Gregg (R) once said when Republicans were utilizing the tactic, Reconciliation is a rule of the Senate set up under the Budget Act. It has been used before for purposes exactly like this on numerous occasions. The fact is, all this rule of the Senate does is allow a majority of the Senate to take a position and pass a piece of legislation, support that position. Is there something wrong with majority rules? I dont think s