Before he was the architect of the Affordable Care Act (ACA), the nation’s most significant health care legislation since Medicare and Medicaid, Barack Obama’s passion for providing health insurance to low and middle class families stemmed from his time as a state legislator in the General Assembly. As a state senator representing Chicago’s Southside, Obama pressed hard at reforming the state’s health care laws and those initiatives were the genesis that would ultimately lead to the ACA.
The Becoming of a State Senator
As Obama entered the General Assembly in 1995, he found himself in the minority party. The political environment had shifted nationally to the right, as Newt Gingrich’s “Contract with America” rhetoric against President Clinton and his failed bid at health care reform had successfully appealed to voters and restored GOP control of the U.S. House of Representatives for the first time since 1952.
The national shift trickled down to Springfield, altering the political environment. Then House Speaker Michael Madigan, who had served in that position for the previous twelve years, suddenly found himself in the wilderness as Democrats conceded control to Lee Daniel’s GOP. Moreover, Senate President James “Pate” Phillip had come to power two years prior. With Gov. Jim Edgar maintaining the Governor’s Mansion, the GOP had total control of state government.
Republican control made any push for health care reform unlikely, with the national GOP’s primary initiative the last two years being to thwart any attempt. However, that did not deter the young state senator. According to biographer David Garrow, Obama would frequently introduce a constitutional amendment establishing healthcare as a “fundamental right” in the state of Illinois.
Obama’s Legislative Actions with Healthcare
The political pendulum had finally swung in favor of Democrats in November 2002. Although Michael Madigan had regained control of the Speaker’s gavel in 1997, the Senate remained in Republican hands. That all changed when the son-in-law of a Chicago Alderman from the Northwest Side named Rod Blagojevich defeated scandal-riddden incumbent governor George Ryan. The window of opportunity to get something done on health care finally opened for Senator Obama.
In 2003, he was appointed chair of the Health and Human Services Committee by then Senate President Emil Jones Jr. Previously chaired by Rockford Republican Dave Syverson, the Committee is obligated with advancing any type of health-related initiatives prior to making it to the Senate floor. The State Journal-Register reported that Senator Syverson “took pride in blocking some of future president’s initiatives.” However, the two lawmakers would ironically become partners in a future initiative to help expand coverage for children.
The KidCare Program
Prior to the passage of the ACA, health care initiatives that were considered popular and politically safe were to expand coverage for seniors and kids. The state had a popular program called KidCare, which provided health coverage to low-income children belonging to families 185 percent below the poverty level. However, the program was only temporary and Obama made it a priority to get more children insured.
In 2003, he and Syverson sponsored a law to expand coverage to children 185 percent below the poverty line to 200 percent. The 15 percent increase made a significant impact on the lives of many, as an additional 20,000 children and 65,000 more Illinois adults gained coverage. By 2007, that number had grown to 70,000 kids and 84,000 adults.
Hospital Report Card Act
That same year, Obama also introduced legislation to make hospitals operate more efficiency and hold them accountable. Called the Hospital Report Act, the bill set state standards hospitals must abide by when hiring and training health care workers while also mandating that they staff accordingly based on treatment needed for patients. The big piece of the legislation, however, was a requirement that hospitals publish a report every quarter disclosing key information such as nursing hours and infection-related measures as well as outcomes. Obama believed making more information available through hospital reports would help consumers make better health care decisions.
Health Care Justice Act
Even before he was elected to the General Assembly, Obama was always perplexed at the idiosyncrasies of the current U.S. health care system; one where a middle class family can be bankrolled by medical bills simply because someone fell ill.
While Senator Obama was successful at helping pass legislation to expand health care access, the Senator’s true passion was making sure families were adequately covered. He had been interested in the concept of a universal coverage system, where health care is provided to citizens without financial hardship. Although this goal could be obtained in many ways, functioning and success of such a system required the government play a central role in achieving outcomes. Despite multiple prior attempts, the United States remains the only industrialized nation, and wealthiest, without such as system.
Although primarily a national issue, Obama believed he could nonetheless push for systematic reform at the state level. Any success of reform, however, demanded he build coalitions. He was already an alley with Jim Duffett, executive director of the Campaign for Better Health Care. Founded in 1989, the organization built coalitions to fight for universal health care. Upon the Democrats retaking power in 2003, Obama reached out to Duffett to discuss future initiatives.
Their original idea was to get the Generally Assembly to pass a proposal authorizing a state commission to analyze the concept of universal coverage for the state. When word spread about the project, Obama quickly received backlash from GOP opponents, including Syverson and future congressman Peter Roskam. The future success of any legislation demanded Obama make comprises.
Republicans, knowing Obama’s biased towards a universal coverage, feared that the resulting language of the report would imply the state adopt such a plan. Obama negotiated to make any recommendations from the report nonbinding. The final product encouraged the state to adopt a plan which:
- Provides access to a full range of preventive, acute and long-term health care services;
- Maintains and improves the quality of health care services offered to IL residents;
- Provides portability of coverage regardless of employment status;
- Provides core benefits for all IL residents;
- Encourages regional and local consumer participation;
- Contains cost-containment measures;
- Provides a mechanism for reviewing and implementing multiple approaches to preventive medicine based on new technologies;
- Promotes affordable coverage options for the small business market.
Aside from the requirements, the act also required the General Assembly to adopt a task force, with public input, to help contract the plan. Called the Adequate Healthcare Task Force, the non-standing committee was made up 29 members and and completed its work in January 2007, nearly three years after the Health Care Justice Act was passed.
Adequate Healthcare Task Force Report
The final report included a healthcare expansion plan which provided healthcare to Illinoisans 400 percent below the poverty level through subsidized coverage options and created a plan for the state to partner with employers to provide healthcare to workers.
For Obama, timing of the Health Care Justice Act being passed could not have been better, as it gave Obama much needed visibility in the midst of his U.S. Senate campaign against Republican Alan Keyes. The year 2004 put Obama center stage when he delivered a keynote address at the Democratic Convention in July. Articulate and concise in his communication, people took notice and regarded Obama as a political star in the making. Nobody could have guessed, however, that defeating Keyes three months later would propel him to become the first African American president a mere four years later.
Obama’s time in the General Assembly helped him build coalitions, foster relationships, and, most importantly, provide much needed legislative experience to help turn an idea into law. Springfield helped him develop a keen sense of legislative networking, knowledge of parliamentary procedure, and political skill required to actually get initiatives done. Indeed, the seeds of Obama’s healthcare reform were first planted here in the Prairie State.