Overview

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into law, providing every American with the opportunity to have guaranteed health care coverage. The Affordable Care Act—frequently referred to as Obamacare—is almost synonymous with Obama’s presidential legacy and reflects a series of key decisions that he made beginning before he took office. As Meena Bose shows, it was Obama’s particular brand of pragmatic politics that ultimately shaped the passage of the Affordable Care Act and made a lasting mark on health care reform in the United States.Pragmatic Vision examines eight of Obama’s decisions that resulted in the landmark enactment of health care reform, starting with his commitment to health care reform in the 2008 presidential campaign and concluding with his decision to allow for flexibility with its implementation, following technical hurdles and Supreme Court rulings. Bose shows that Obama’s steadfast commitment to the issue was crucial to its passing, especially after the Democrats lost their filibuster-proof majority in the Senate. Obama’s direct engagement built key political support for the legislation and was aided by the senior White House staff and Democratic leaders in Congress who skillfully navigated the bill to passage just fourteen months after Obama took office. The story of Obama’s leadership in enacting the Affordable Care Act is a tale of today’s partisan divide and the polarization of Congress. The legislation passed on a party-line vote and continued to divide politicians long after its passage. Nevertheless, despite repeated efforts by Republicans to repeal the law, it is more popular today than ever and seems destined to remain in force until the next stage of reform. Pragmatic Vision is an authoritative guide to this singular achievement of the Obama administration.

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9780700637447

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Reviews

"""In the decades that followed the passage of Medicare and Medicaid, countless attempts to reform the troubled US health care system met with certain demise. The exception to the rule was the Patient Protection and Affordable Care Act, passed along partisan lines and signed into law by President Barack Obama in 2010. This success, as Meena Bose illustrates in this masterful book, owes much to Obama's assertive presidential leadership style. Learning from prior presidential failures to navigate the gauntlet of organized interests and congressional veto points, Obama's decisions at every stage of the policymaking process moved the bill to its dramatic final passage and guided it through an onslaught of post-enactment challenges. A leading expert on presidential policymaking, Bose weaves together penetrating analytical insights into a highly readable narrative. This book is essential reading for anyone interested in the challenges of crafting landmark legislative reforms in a polarized age.""--Philip Rocco, coauthor of Obamacare Wars: Federalism, State Politics, and the Affordable Care Act ""The passage of the Affordable Care Act was Barack Obama's signature domestic policy achievement, succeeding where many presidents of both parties had failed. In this concise, fascinating and highly readable account, Meena Bose, one of the foremost scholars of the American presidency, trains her analytic lens on the complicated dynamics that implicate all of modern politics, including partisan polarization in Congress, presidential leadership, presidential-congressional relations, and the innerworkings and compromises that led to the signing the act, barely a year into Obama's presidency. Pragmatic Vision will make its way onto course syllabi (it's already required reading for my class on Congress and the Presidency), as well as become a standard source for researchers of the Obama presidency generally and healthcare policy-making specifically.""--Daniel E. Ponder, author of Presidential Leverage: Presidents, Approval, and the American State"

"""In the decades that followed the passage of Medicare and Medicaid, countless attempts to reform the troubled US health care system met with certain demise. The exception to the rule was the Patient Protection and Affordable Care Act, passed along partisan lines and signed into law by President Barack Obama in 2010. This success, as Meena Bose illustrates in this masterful book, owes much to Obama's assertive presidential leadership style. Learning from prior presidential failures to navigate the gauntlet of organized interests and congressional veto points, Obama's decisions at every stage of the policymaking process moved the bill to its dramatic final passage and guided it through an onslaught of post-enactment challenges. A leading expert on presidential policymaking, Bose weaves together penetrating analytical insights into a highly readable narrative. This book is essential reading for anyone interested in the challenges of crafting landmark legislative reforms in a polarized age.""--Philip Rocco, coauthor of Obamacare Wars: Federalism, State Politics, and the Affordable Care Act ""The passage of the Affordable Care Act was Barack Obama's signature domestic policy achievement, succeeding where many presidents of both parties had failed. In this concise, fascinating and highly readable account, Meena Bose, one of the foremost scholars of the American presidency, trains her analytic lens on the complicated dynamics that implicate all of modern politics, including partisan polarization in Congress, presidential leadership, presidential-congressional relations, and the innerworkings and compromises that led to the signing the act, barely a year into Obama's presidency. Pragmatic Vision will make its way onto course syllabi (it's already required reading for my class on Congress and the Presidency), as well as become a standard source for researchers of the Obama presidency generally and healthcare policy-making specifically.""--Daniel E. Ponder, author of Presidential Leverage: Presidents, Approval, and the American State ""Pragmatic Vision tells the unlikely tale of how the landmark Affordable Care Act endured a journey through a fractious Congress, tempestuous roll out, treacherous court challenges, and relentless efforts by Republicans to repeal it. Meena Bose, a foremost scholar of presidential studies, shows how presidential leadership matters in a polarized age that makes enacting and implementing transformative legislation seemingly quixotic. She serves up a clear-eyed, blow-by-blow account of the stewardship of Barack Obama, who overcame the odds with a rare combination of idealism and perspicacity.""--Sydney M. Milkis, author of Theodore Roosevelt, the Progressive Party, and the Transformation of American Democracy ""Over the past fifteen years the Affordable Care Act has made it over numerous hurdles--in Congress, in the courts, in its executive implementation, in the sphere of public opinion. In this book Meena Bose manages to be both concise and systematic in analyzing the key presidential decisions that set the ACA down that track. In so doing she provides an invaluable guide to how individual leadership matters as it interacts with the institutions of American governance.""--Andrew Rudalevige, coeditor of The Obama Legacy"

Author Information

Meena Bose is Executive Dean for Public Policy and Public Service Programs in the Peter S. Kalikow School of Government, Public Policy and International Affairs, and Director of the Peter S. Kalikow Center for the Study of the American Presidency at Hofstra University. She is also the author of Shaping and Signaling Presidential Policy and an editor of Executive Policymaking: The Role of the OMB in the Presidency.

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