The Obama Legacy: We Finally Have Health Care and Now Congress Is Threatening to Destroy It

The Affordable Care Act’s passage in 2010 was one of the most significant social innovations in the past half-century. After repeated, failed attempts at reform—dating back more than a half-dozen Presidents to FDR—President Obama succeeded in securing major changes to America’s health care system.

More than 22 million uninsured people gained health coverage, resulting in the lowest uninsured rate in U.S. history. People with pre-existing health conditions can no longer be denied coverage by insurance companies. Annual and lifetime caps in insurance payouts are barred, thereby protecting people with major illnesses and accidents. Health care coverage must be comprehensive—it cannot be filled with holes. Women can no longer be discriminated against in premium costs. Young adults can stay on their parents’ insurance plans until their 26th birthday. Preventive care is provided at no cost.

These changes have made a huge difference in the lives of millions of people. Because of the Affordable Care Act (ACA), all Americans are far less likely to go bankrupt after a major accident, or be penalized for chronic conditions, or have a minor illness spiral into a serious medical problem. There has also been remarkable progress in extending coverage to low- and moderate-income families and individuals.

To be sure, the new law is far from perfect. There are still millions of people who don’t have health coverage, in part because 19 states have refused to expand Medicaid. In the individual private insurance marketplace, fewer insurers are selling coverage and premiums are rising at unacceptable rates. High-quality care still has too high of a price tag. But the ACA established a strong foundation that we can build on.

Unfortunately, the progress we have made may soon be reversed. President-elect Trump and congressional Republicans are determined to repeal the law. They also want to convert the Medicaid program—which currently serves more than 73 million low-income people—into a block grant with significantly diminished funding. These changes to Medicaid would kick people off of the program, reduce its coverage, and lead to deductibles and co-payments that recipients cannot afford.

For nearly seven years, we have heard from conservatives that they will repeal and replace the ACA. While congressional Republicans now have a clear plan to repeal the law—in short, to repeal it in early 2017 but delay implementation so that people don’t start losing their insurance until after the 2018 midterms—they have not put forward a unified proposal on what to replace it with. That means when they vote to repeal the bill, they will have no idea what the changed health care system will ultimately look like.

If Congress moves forwards with this half-baked plan, an estimated 30 million people will lose health coverage, while the wealthy receive massive tax breaks. That would more than double the uninsured rate, and flip the country from having its lowest uninsured rate in history to its highest in decades. Eighty-two percent of the people who will lose coverage are in working families, and four out of five don’t have college degrees. These numbers will be even higher if the ACA repeal is combined with the proposed restructuring of Medicaid.

Millions of Americans would be priced out of the care they need.

The net result is a lose-lose-lose-lose proposition. Millions of Americans would be priced out of the care they need. Many hospitals, especially those in rural and low-income communities, will need to close because they cannot afford to care for uninsured patients. And the health care sector will face enormous job losses, which would have a major ripple effect throughout the economy. Finally, states would not only lose significant federal revenues, they would face an increase in expenditures to help pay for some care for the newly uninsured.

A new coalition, “Protect Our Care,” is focused on helping the public understand the harmful consequences we would face if the ACA is repealed and Medicaid is gutted. The coalition aims to ensure that its education and mobilization effort effectively reaches the public, opinion leaders, and policymakers before it is too late.

It behooves people of good will, from both political parties, to work together to ensure that we continue to improve our health care system—not take large steps backwards that would create chaos.

Editor’s note: TalkPoverty presents this series in collaboration with the Georgetown Center on Poverty and Inequality.

When Barack Obama walks through the doors of the White House for the last time as President next month, it will mark the end of an era for our nation.

From my seat in the United States Senate, I can attest that the last eight years have certainly not been free of strife or confrontation, to say the least. But despite all the political posturing and polarization, the past eight years have also shown us at our best. We have sought to build up our fellow citizens and fellow human beings instead of tearing them down, and made progress in the face of adversity.

Nowhere is the hope and promise of the last eight years better exemplified than in the progress we have made in achieving equality for the LGBTQ members of our American family.

In January 2009, when President Obama first took office, it was not a federal hate crime to attack someone because of their sexual orientation or gender identity. Same-sex marriage was only legal in two states. LGBTQ people could not serve openly in the military, or access their partners’ survivor benefits or health insurance. They were anxious and unsure—should a crisis arise—about whether they would be allowed to make medical decisions for their families, or see them in the hospital during an emergency, or keep their home if their partner died.

Slowly—often too slowly—we have broken down the barriers that divide us.

For over two hundred years, the story of America has been one of striving to live up to our founding ideal “that all men are created equal.” Slowly—often too slowly—we have broken down the barriers that divide us; that say some of us are more equal than others. For the LGBTQ community, many of the biggest, most daunting barriers that they had faced for generations finally came down during President Obama’s administration. The millions of men and women within the LGBTQ community, who struggled for so long to be treated equally and enjoy all the same rights and opportunities as their fellow citizens, can attest to just how momentous the last eight years have been.

With the historic passage of the Affordable Care Act, it is no longer legal to deny health coverage to anyone because of their sexual orientation or gender identity. The President also decided that the government would no longer defend the Defense of Marriage Act (DOMA) in court, even before the Supreme Court struck it down as unconstitutional. He took this path because he believes, as he said during his second inaugural address, “that the most evident of truths—that all of us are created equal—is the star that guides us still.” And when the Supreme Court finally affirmed that “love is love” by ensuring marriage equality in every corner of our nation, President Obama declared it “a victory for America” and his administration moved quickly to implement the court’s ruling.

From my position at the other end of Pennsylvania Avenue, I have been privileged to work with the President and members of his administration to advance the rights of the LGBTQ community in Congress. We worked together to pass the Matthew Shepard Hate Crimes Act, repeal “Don’t Ask, Don’t Tell,” and reauthorize the Violence Against Women Act with new protections for the LGBTQ community. In an historic, bipartisan vote, we passed the Employment Non-Discrimination Act in the Senate to ensure employers could no longer fire someone for who they are or whom they love. And though the House failed to act on this legislation, President Obama issued an executive order in July 2014 that secured this right for the 28 million Americans working for federal contractors.

But President Obama and I both know that as long as anyone is scared to put their spouse’s photo on their desk at work, or fears being evicted from their apartment if they have a same-sex partner, then our nation has not come far enough or broken down enough barriers.

That’s why I have worked with my House and Senate colleagues, President Obama’s administration, and an extraordinary coalition of grassroots and civil rights groups to craft the Equality Act, landmark legislation that would extend the same non-discrimination protections that so many of us take for granted in employment, housing, public accommodations, and more to our LGBTQ brothers and sisters.

We are proud President Obama endorsed our bill, one that his White House described as “historic legislation that would advance the cause of equality for millions of Americans.”

It’s up to the rest of us to keep up the struggle.

When the new administration comes into office on January 20, we will face a White House that is indifferent at best and hostile at worst when it comes to LGBTQ rights. It’s a daunting moment, especially in the face of all our gains over the last eight years. But these new challenges only make it more important for Americans who care about the rights of our fellow citizens to keep fighting—not just to fiercely defend the gains we have made, but to continue pushing on for full equality.

On the day we introduced the Equality Act, I knew the struggle to pass it would not be an easy one. But I was convinced then, and I remain convinced today, that we will ultimately succeed. The arc of the moral universe is long, as Martin Luther King Jr. said, but it bends towards justice. But, it only bends when good people fight for justice. President Obama’s legacy on LGBTQ rights shows us that with hard work and struggle, we can bend the arc quite far in just a few years.

Now, it’s up to the rest of us to keep up the struggle, to do everything we can to ensure that justice reigns in our nation—and that every American, regardless of race, color, creed, sex, national origin, sexual orientation, or gender identity, can live freely and equally in the eyes of the law.

Editor’s note: TalkPoverty presents this series in collaboration with the Georgetown Center on Poverty and Inequality.

Eight years ago, America was facing one of the worst economic crises in our history. An optimistic young president swept into office and set to work rebuilding and renewing America’s promise that everyone, no matter who they are, deserves a chance to succeed.

Our public school system has always been fundamental to that promise.

Three weeks into the new administration, President Obama signed a law providing $100 billion in additional funding for education. While most of that money went to states to protect teaching jobs, support low-income and special needs students, and provide college grants, $5 billion was set aside to drive reform and innovation, and another $3 billion for turning around our lowest-performing schools. President Obama also made a number of significant investments over the course of his tenure, including increasing funding for Pell Grants by more than $50 billion and increasing investments in early childhood programs by more than $6 billion.

Today, much has changed for the better in American education. Others can decide how much change is due to our efforts, but America’s progress since 2008 is undeniable:

Most states have higher learning standards and better assessments.
We have more children in early learning programs.
We have more high-quality school options available.
We have countless examples of evidence-based innovation to learn from.
Students enjoy greater protections from violence, discrimination, and inequity thanks to an invigorated Office of Civil Rights.
Many more students have high-speed internet access.
Test scores for the lower grades are up.
We have cut “dropout factories” with unacceptably low graduation rates by 40%, and the nation’s high school graduation rate is at an all-time high of 83%.
We have more young people in college and more college graduates from low-income families.
Many of our community colleges are better aligned to the needs of local employers.
All colleges—public, private, and for-profit—face more pressure to graduate their students instead of merely enrolling them and allowing them to drop out.

But, this is no “mission accomplished” moment. We still have many unmet challenges:

Too many children show up in kindergarten behind their peers due to a lack of access to pre-K programs and other factors.
Too many young people are still trapped in underperforming schools.
Too many schools lack the needed resources to serve the growing low-income population.
We still disproportionately suspend and expel students of color.
Inequality persists in funding and access to rigorous college prep courses.
High school test scores are mostly flat and many high school graduates are not ready for college or careers.
We don’t do nearly enough to prepare young people in high school to go straight to work, if that’s what they want to do.
Too many college students and graduates are struggling with student debt while too many low-income students are priced out of college altogether.

Congress and the President have helped lay a foundation to address some of these issues. We have a new federal education law that makes needed and important changes. For the first time, states must adopt challenging academic standards that are aligned with college entry requirements and career-ready standards, so it’s unlikely that states can retreat. The new law also acknowledges that learning starts at birth, and encourages investment in early learning programs.

The law moves us away from accountability based on a single test score to one based on multiple factors, like graduation rates. I have often said that the prior version of the law, known as No Child Left Behind, was “loose on goals but tight on means,” because it didn’t demand high standards and it was too prescriptive about how to improve. The new law flips that around and gives states more flexibility to implement reform and accountability.

Now it falls to the next administration to maintain a high bar, continue the progress, and stay focused on our national goals. These four goals are neither Democratic or Republican, left or right, liberal or conservative:

Leading the world in early childhood education.
Boosting high school graduation rates to 90% and beyond.
Making sure 100% of high school graduates are truly college and career-ready.
Leading the world in college completion.

While state and local governments will always play the predominant role in education, the new administration needs to understand the historic role that the federal government has played in driving equity, and promoting excellence and innovation.

Thanks to the federal government, we have a world-class system of public universities. Thanks to the G.I. Bill, we won the peace after World War II. Thanks to the federal government, millions of low-income students can go to college.

Thanks to the Supreme Court, segregation in public schools is no longer the law of the land. Thanks to the federal government, America protects the rights of students with disabilities and it dedicates funds for English-language learners, and homeless, migrant, and rural students.

Parents don’t care all that much which level of government pays for education, makes the rules, or holds the system accountable. They just want what’s best for their kids—and that’s what we should all want.

Change can be perilous or promising.

It’s a new day in Washington, and change can be perilous or promising. The perils are obvious: a retreat from accountability, an unwillingness to defend the most vulnerable, and a divided country that no longer views education as a shared opportunity to lift all boats. Instead, education is rationed to those with the means to acquire it—rather than extended to all those with the talent and the will to gain the most from it.

The promise, on the other hand, is infinite—a world where every child has the opportunity to rise from nothing to something, to fulfill his or her destiny and to realize the American dream. If we want to reduce income inequality and increase social mobility, the only way to do that is to give every child a world class education. It’s the best investment we can make.

As a citizen of the greatest country in the world, I always root for the success of those who serve, regardless of political affiliation. But, let’s remember that success in education is measured not by laws or rules, courtroom battles, political campaigns, or the size of the federal footprint, but by student outcomes.

Let’s keep our eyes on the prize.

Editor’s note: TalkPoverty presents this series in collaboration with the Georgetown Center on Poverty and Inequality.

On January 29, 2009—just over a week after his inauguration—President Obama sat down at his desk in the Oval Office and signed his very first bill: the Lilly Ledbetter Fair Pay Act. The legislation was named after a woman who had been paid significantly less than her male colleagues for over a decade, and it ensured that employees have the right to sue for pay discrimination.

President Obama’s action gave women a stronger tool to fight for equal pay, and it made them more financially secure. It also signaled clearly that our president was going to spend his term fighting for a woman’s right to have the same chance as a man to succeed, to have a better shot at escaping poverty, and to create a better life for themselves and their families.

Facing opposition from an unfriendly Congress, President Obama signed executive orders granting federal workers and contractors a higher minimum wage and paid sick days, making pay more transparent by requiring government contractors to give their employees the necessary information each pay period to make sure they are getting paid what they are owed, and making workplaces safer by allowing victims of sexual assault or harassment their day in court. These reforms were key for women, who make up the majority of minimum wage workers and who are often tasked with caring for dependents when they are sick. Making pay transparent also helps employees to know if their pay is lower than other similar employees—which could be an indication of pay discrimination.

President Obama also enacted one of the most significant anti-poverty measures in years when he expanded the Earned Income Tax Credit and the Child Tax Credit in the stimulus bill. Between 2009 and 2011, these expansions kept 9 million people out of poverty. They were particularly crucial for women and their families, who would have lost over $8 billion in tax assistance if the reforms had been allowed to expire.

Additionally, President Obama vigorously enforced civil rights laws, which removed impediments to opportunities for women and girls. The Obama administration stepped up enforcement of Title IX to combat sexual assault in universities and colleges, as well as K-12 schools. He also fought for and signed the 2013 reauthorization of the Violence Against Women Act, which was expanded to better protect all women, including LGBTQ individuals, American Indian and Alaskan Native women, and women who are undocumented immigrants.

Arguably no legislation during the Obama years did more for women’s equality than the ACA.

But arguably no legislation during the Obama years did more for women’s equality than the Affordable Care Act (ACA). For many years prior to the passage of the ACA, health care costs were the leading cause of bankruptcy filings—meaning that many women and families were just one medical emergency away from financial ruin. Additionally, simply being a woman was considered a pre-existing condition, which allowed insurance companies to charge women more for health coverage. In fact, before the ACA, 92% of health insurers gender-rated their plans—charging women more than men for their plans—even when maternity coverage was excluded. Women are unfortunately used to paying more for things labeled as “for women,”—for jeans, razors, or beauty products, for example—but health insurance is no longer one of those things.

In total, nearly 10 million women gained health coverage since the enactment of the Affordable Care Act. Medical bankruptcies decreased, as did the share of Americans struggling to pay their medical bills. Insurance companies can no longer charge women more than men because of their gender. And through Medicaid expansion—in the 32 states and DC that expanded Medicaid as the law intended—low-income women gained access to health care and mandated coverage of many core preventative services, including contraception.

These significant achievements have made a real difference in women’s lives. Thank you, Obama. Really. Thank you a million times over.

Now, as Obama concludes his presidency, much of the progress of the past eight years is threatened. We have replaced our unabashedly feminist president with a president who isn’t quite convinced that women should be allowed to work. Additionally, President-elect Trump and Congressional Republicans have made repealing the ACA their banner cry, and Trump has promised to appoint a Supreme Court justice who will overturn Roe v. Wade. Meanwhile, Speaker Ryan has argued for the block granting of Medicaid, housing, nutrition assistance, school lunches and more, and for dramatic cuts to social safety net programs—all while potentially slashing taxes for big corporations, millionaires, and billionaires.

The fight ahead to preserve our progress is daunting, but we’re ready. The well-being and economic security of women and families are worth fighting for with everything we’ve got.

Editor’s note: TalkPoverty presents this series in collaboration with the Georgetown Center on Poverty and Inequality.

I have spent the last 50-plus years of my life fighting poverty. In 1967, when I worked for Senator Robert Kennedy as his legislative aide, the Senator and I traveled to Mississippi. We saw children starving—literally—with bloated bellies, open sores that wouldn’t heal. Our nation did the right thing then—we expanded the food stamp program—and that’s why you don’t see that kind of starvation here today.

But we had to fight for it. And now we are going to have to fight again.

During his presidential campaign, Donald Trump spoke about America’s inner cities in dystopian terms, rendering a picture even more dire than the real one (which is plenty bleak). He promised that he would fix everything, without providing any specifics. But city leaders were quick to point out that he wasn’t really speaking to the residents themselves, who understand the challenges their communities face on a daily basis. Instead, he chose to play up stories about crime and violence to appeal to the worst instincts of white voters.

If President-elect Trump had a real interest in addressing concentrated urban poverty, he could build on President Obama’s record and learn about the important work that is already happening in every major city.

Instead, we will soon see an all-out attack on virtually every federal program that helps low-income people, from cradle to the grave, wherever they live. It will put millions of Americans at risk, whether it’s losing food or health care or housing. Anyone who cares needs to join in fighting back—those who are directly suffering, and those who have the privilege to remain untouched by retrogressive policy. At the same time, we can’t limit ourselves to defensive action—we need to put forth a vision for our future and work toward its realization.

Many of the policies that low-income neighborhoods need do not focus on them exclusively. A real full-employment policy would help beached boats float wherever they are, and raising the minimum wage would help low-wage workers across the country climb out of poverty.

Obama understood that the quality of life in high-poverty places depends on a mosaic of policies.

President Obama took us forward on these matters, sometimes in big steps and sometimes small. He had many other significant efforts blocked by Congress—such as his most recent jobs proposal, an increased minimum wage, and comprehensive immigration reform. His housing initiatives reflected his commitment to people having a genuine choice about whether to stay in their current community with improved economic conditions or move to opportunities elsewhere. He did not achieve radical change, but he understood that the quality of life in high-poverty places depends on a mosaic of policies—and he was heading in the right direction.

The Obama administration undertook place-based work that targeted rural, urban, and tribal communities. In fact, its efforts to support neighborhood revitalization have been more impressive than any previous administration—even given the funding limitations imposed by the Republican-majority Congress that has been in place since 2010.

Obama’s creation of Promise Neighborhoods, based on the work of Geoffrey Canada and the Harlem Children’s Zone, was a significant innovation towards that end. The initiative uses schools as hubs for community partnerships, where cradle-to-career educational programs and family supports are designed to improve educational and development outcomes for children. Since 2010, a dozen Promise Neighborhoods have received sizable five-year grants for implementation and are operating on a substantial scale.

Through executive action, President Obama also created Promise Zones. These low-income neighborhoods receive preference for funding from a variety of existing federal programs. The marshaling of funds that are already appropriated means that program money is spent where it is needed most, and that’s something that should appeal to progressives and conservatives alike.

The Obama Administration also reconstituted the first President Bush’s HOPE VI into a version 2.0, called Choice Neighborhoods. Had it been properly funded, it would have had more reach in helping to build stronger communities through mixed-income housing, including housing for people with the lowest incomes. This was a key effort given that rental assistance to families with children is at its lowest point since 2004, and homelessness of school-aged children is at a record high.

Support from the Obama Administration—including grants from these place-based programs—have fostered the growth of a number of sophisticated, multifaceted inner-city organizations and partnerships, all doing valuable work for children and families, the elderly, and people with disabilities.

The Youth Policy Institute (YPI) in Los Angeles—which focuses on poverty reduction through support services, educational opportunities, and job training and career support—has been able to use this funding from Washington to further develop its model and reach, and to engage thousands of families with services and supports. The organization’s work includes five of its own schools, after-school programs at 78 schools, and 83 public computer centers. It also offers Early Head Start, teen pregnancy prevention, job readiness, and job placement services. YPI works with families on parenting skills, financial planning, and computer literacy. They help day laborers and teach community agriculture. In all, YPI has 1,600 staff serving more than 100,000 youth and adults at 125 program sites. It works with 60 partners, and has a budget of $41 million annually—and its partners’ budgets add up to a much greater sum.

Because YPI is three decades old and receives state, local, and private funding, it will likely weather a Trump storm; but many newer organizations may face rougher sailing. The competitive funding they’ve received from the Obama administration for the last eight years has been a major factor in their growth.

All of the Obama Administration's place-based work is at risk.

Indeed, now all of the Obama Administration’s place-based work (and more) is at risk.

The Affordable Care Act, Medicaid, SNAP, housing vouchers, and many more critical programs all face the prospect of being totally axed or turned into block grants—either way, it means far less people having access to basic needs like food, housing, and healthcare. Support for good schools and accessible transportation, aggressive enforcement of anti-discrimination laws, and true criminal justice reform—all critical for urban residents—are on the block for deep budget cuts and gutting through executive action.

These cuts, and the weakening of community-based organizations, place children in particular in deep jeopardy. Without a real jobs program and investment in communities that have been stripped of their wealth, families will not have the resources to support the developmental needs of their children. Trump has put out a so-called jobs initiative, but the purported infrastructure plan is nothing but a tax cut to make the rich richer.

Perhaps the threatened Trump cuts reveal the road map we need to fight back. The federal policies helping people—and the initiatives revitalizing neighborhoods—serve millions of people, through thousands of organizations. Businesses and faith leaders, foundations, local public officials and community leaders, and regular people—if we are organized—can stand up and fight back against those who would do us harm.

We’ve done it before and now we must do it once again. This is not over yet.

Editor’s note: TalkPoverty presents this series in collaboration with the Georgetown Center on Poverty and Inequality.

The Obama Legacy: We Finally Have Health Care and Now Congress Is Threatening to Destroy It

The Obama Legacy: Marriage Equality, the Repeal of ‘Don’t Ask, Don’t Tell,’ and the Work That Remains

The Obama Legacy: Equity in Education

The Obama Legacy: Women’s Equality

The Obama Legacy: Place-Based Poverty

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