Excerpt: Healthcare End Game

At the beginning of 2010, health care reform had passed both the House and Senate (where Democrats had 60 votes) and was merely awaiting the resolution of the differing versions of the bill. Through endless meetings Obama stayed patient. With another week or two of talks, his aides thought, he would have a final bill approved. Then he could pivot fully to jobs in his State of the Union Address.

Nine days before the January 19 special election in Massachusetts to fill Ted Kennedy's seat, two public polls landed like grenades in the White House. The first, by the Boston Globe, had the Democratic candidate, Attorney General Martha Coakley, up by seventeen points. This was consistent with earlier surveys that showed her cruising to victory. But a second poll, by Public Policy Polling, showed a dead heat between Coakley and Republican Scott Brown, a state senator best known for having posed nude for Cosmopolitan as a young man and for being the father of an American Idol contestant. Senate staffers later said that had they known earlier that the race was going to be close, they would have worked right through Christmas and New Year's to finish the bill.

David Axelrod immediately offered to send reinforcements—seasoned political operatives—from Washington. At first, the Coakley campaign said no. Coakley had taken a six-day vacation in the Caribbean three weeks before the election—an unforgiveable sin in politics—and with a week to go compounded the error by traveling to Washington for a fundraiser hosted by K Street lobbyists (immediately exploited in a TV ad by Brown).

On January 13, a week before the election, a quote appeared in the middle of a Boston Globe story that would soon be remembered as one of the great gaffes of modern American politics. The Brown campaign had posted video of its candidate shaking hands outside Boston's Fenway Park, a shrine in Massachusetts. A Globe reporter asked Coakley why she was in Salem at a rally of the Salem School Committee instead of meeting voters. "As opposed to standing outside Fenway Park? In the cold? Shaking hands?" Coakley said dismissively.

The next morning, Obama, who had been keeping up with the race since the first disturbing poll, wandered into Axelrod's office as usual. When Axelrod told him the Fenway story, the president reached out and grabbed his shirt.

"No! No! You're making that up! That can't be right! Tell me she didn't say that!" Obama said, with a few obscenities tossed in. That was the moment the full weight of it hit him. Coakley would lose. Health care was in deep trouble and so was his presidency.

Of all the lessons offered by pundits, Democratic members of Congress from swing districts learned only one: You're on your own. Obama has no ability to save you. Even Barney Frank said publicly that health care reform was dead, and he had a lot of company.

Even before Scott Brown won, the White House began devising a new strategy. Thank God, one advisor said, for the State of the Union Address, which was quickly moved up from early February to January 27. That would let the president push the reset button for his second year right away.

In the big speech, Obama doubled down on his proposal, dared Republicans to come up with something better, and reminded fellow Democrats, "We still have the largest majority in decades, and the people expect us to solve some problems, not run for the hills."
"We don't quit," the president said. "I don't quit."

After a period of despondency, the bill miraculously revived, in part because one insurer, Anthem Blue Cross of California, announced a 39 percent rate hike in the middle of the debate. Democrats needed no Republicans; they just had to unify among themselves. When the president met twice with Republicans on television, it reminded House Democrats that while they resented Senate Democrats for their behavior all year, they loathed Republicans even more.

The endgame provided the highest drama of the Obama administration to date. On March 12, Pelosi sent a memo to the House Democratic caucus insisting that "we have to just rip the Band-Aid off and have a vote."

For six weeks Pelosi had been promising she could get the votes, even when it looked like she and the president would have to rustle up a daunting sixty eight of them. Now the tenacious speaker began to prove it, as each day in the last week before the scheduled March 21 climax brought a few more private commitments.

The public focus was on Bart Stupak and the fight over abortion but behind closed doors the broader deal was in trouble. At 11:30 p.m. on Friday March 19, two days before the final vote, Congressman Ron Kind of Wisconsin, one of the coalition's negotiators, stormed out of the speaker's conference room. He was unhappy with the White House's position and was taking the American Medical Association with him. The negotiating ploy worked and by 3:00 a.m. the holdouts had a deal with the White House. It had to stay secret before the vote or the regional adjustments HHS Secretary Kathleen Sebelius agreed to in writing would smack of "Cornhusker" giveaways. Just as with the stimulus a year earlier, the short strokes were all about funding formulas.

Even with the outcome clear, the final vote played on TV like a cliffhanger. At the White House, the Roosevelt Room was packed with staffers in jeans watching C‑ SPAN. It felt like Election night though Obama said he was even happier now. The president came in ten minutes before the vote, bringing cheers. Afterward he gave everyone in the room a hug: "Thanks so much. Great work."

The next morning, David Axelrod spoke movingly in a senior staff meeting about what the bill meant for people like his daughter Lauren, who suffers from epilepsy. In the Situation Room, the president and Hillary Clinton hugged each other tight. Just before signing the bill on March 23, Obama hugged Biden, who whispered, "This is a big f-ing deal." After the gaffe was picked up by a microphone, Gibbs tweeted: "And yes, Mr. Vice President, you're right." With twenty-two pens the president signed the bill. Later he summarized the ambitions of his presidency. "We don't fear the future. We shape the future!" he exulted. Barack Obama had won ugly—without a single Republican—but won all the same.

From The Promise: President Obama, Year One, by Jonathan Alter. To be published on May 18 by Simon & Schuster, Inc. © 2010 by Jonathan Alter.