CARROLL, Iowa — Bernie Sanders, like many progressives, wasn’t happy with President Obama’s signature domestic achievement when it became law. The Affordable Care Act, many on the left said at the time, was too watered-down, too tied to health insurance companies, too much of a compromise to make a real difference.
For the most part, the left has come around on the health care law. Obama’s legacy as a progressive has become an important part of left-wing lore, and unyielding Republican resistance to the legislation has helped to rally liberal support for it. The liberals who once railed against Obamacare now often defend it as an achievement of the last decade.
Among them: Sanders. Faced with a barrage of attacks from Hillary Clinton defending the Affordable Care Act and warning voters that a push for a single-payer system like the one Sanders supports could mean scrapping the law and starting over, and that the votes weren’t there for single-payer even in the Democratic majority days of 2009, Sanders has cast himself as a friend of Obamacare and the candidate who wants to take what Obama started and move it to the next level.
“We're not going to tear up the Affordable Care Act. I helped write it,” Sanders said on the debate stage Sunday night. “But we are going to move on top of that to a Medicaid-for-all system.”
One former Obama administration aide who helped lead the slog through healthcare in 2009 recalled Sanders’s role in the legislation very differently.
“It’s difficult to comment on Bernie Sanders’s role in crafting the Affordable Care Act because he played virtually no role in crafting the Affordable Care Act,” the former aide told BuzzFeed News. “Voting on something and working on something are two very different things.”
Jonathan Gruber, the health care policy wonk and MIT professor who first helped craft Romneycare before helping the White House guide its own version of the Massachusetts health care system through Congress, told BuzzFeed News Sanders was not one of the key architects of the law.
“He certainly was not a leader on the legislation and did not contribute in any way to the coverage portion of the bill,” Gruber said. He allowed that Sanders “may have worked on other parts of the bill that I was not involved in.”
Politifact found Sanders to be overstating his role in crafting the ACA a bit. On his contention that he “helped write” the law, the fact checking site ruled Sanders was “mostly false.”
Sanders served on the Health, Education, Labor, and Pensions panel — the so-called HELP committee — during the yearlong push to craft and pass what would become the Affordable Care Act. On the debate stage, he explained his role in its final language.
“I made the Affordable Care Act along with [Rep.] Jim Clyburn [a Democrat from South Carolina] a better piece of legislation,” Sanders said. “I voted for it, but right now, what we have to deal with is the fact that 29 million people still have no health insurance. We are paying the highest prices in the world for prescription drugs, getting ripped off.”
The addition Sanders refers to is the $11 billion in funding for Community Health Clinics, which expand access to primary care for poorer Americans, especially those living in rural areas. It’s a big deal, and one of the few ACA items Republicans consistently try to keep in operation.
Back in 2009, the community health center funding switched Sannders from a no to a yes vote for the ACA in the months before final passage of the law. Sanders “took credit for $10 billion in new funding for community health centers, while denying it was a ‘sweetheart deal’” Politico reported at the time. “He was clearly more enthusiastic about a bill he said he couldn’t support just three days ago.”
Sanders’s tone on Obamacare these days suggests he considers it a good idea that now needs fundamental changes to make it closer to single-payer. That’s close to what Sanders has said in the past with a key change — the emphasis is more on the “good idea” vs the “needs fundamental changes.”
“Yesterday evening some of us met with the Leader, Senate Leader, Harry Reid, to make it very clear that we believe, absolutely, that any kind of legislation coming out of the Senate has to have a strong public option,” Sanders told the progressive radio show Democracy Now in October 2009.
The public option was a progressive goal throughout the fight over the ACA. The idea was that the federal government would run it’s own insurance plan that would compete with private plans offered in the Obamacare insurance exchange. Private companies didn’t like that, and critics said it would be the first step to a European-style single-payer system, where governments pay for everything. The idea was scuttled by health care law supporters during the long slog to passage of the Affordable Care Act.
Sanders criticized the White House for not pushing harder for a public option in the final weeks of the health care debate, which didn’t end until 2010.
"I think we do have 50 votes in the Senate for a public option and frankly I don't know why the president has not put it in and I hope that we can inject it,” Sanders said during those heated final weeks of health care debate. His critique of the bill went on through final passage.
The loss of the public option still stings Sanders, campaign manager Jeff Weaver told BuzzFeed News after Sunday night. But Sanders is now standing much closer to a law he was extremely critical of in the past.
“His goal has always been, as have Democrats since Frankin Delano Roosevelt, he wanted a universal health care system. Obviously the public option was stripped at the last minute by insurance companies and their allies,” Weaver said. “I think everyone understands not everyone got everything they wanted in the affordable care act, not even the admin. that said it was an incredible step forward.”
As for Sanders’s role in crafting the law, Weaver said that his proximity to the process made Sanders a co-author.
“He was on the committee that passed it in the Senate. He worked very closely with Rep. Jim Clyburn...to add a major provision [for] primary health care access through the community health care program,” Weaver said. “So he was a very active participant, he was obviously involved in all the hearings and the markups, and he was on the committee that passed it.”