The Affordable Care Act celebrates its fourth birthday on Sunday, just as its first enrollment period comes to a close.
It has been a long battle to get to this level of implementation — and the fight hasn’t ended yet. From Republicans’ initial resistance to repealing Obamacare in its entirety to their relentless effort to chip away at the law by targeting individual provisions, withholding funding, and undermining implementation, the party is showing no signs of abandoning its anti-Obamacare crusade any time soon.
On this anniversary, ThinkProgress takes a look back at all of the milestones in the GOP’s ongoing campaign to undermine a law that has defined national politics for half a decade:
MARCH 23, 2010: An immediate push to repeal.
- Immediately after President Obama signed the Senate health care bill into law, 13 Republican state attorneys general file a federal lawsuit against the overhaul and Sens. Jim DeMint (R-SC), Rep. Michele Bachmann (R-MN) and Rep. Steve King (R-IA) introduce legislation to repeal the law. King even offers a discharge petition. “If we can get to 218, we can force Nancy Pelosi to bring a repeal to the floor for a vote. If the Senate can do that…we have a chance to put a repeal on President Obama’s desk and make him veto that bill,” King explained. “Repeal and replace will be the slogan for the fall,” Minority Leader Mitch McConnell (R-KY) predicts. Watch a compilation:
- Virginia Attorney General Ken Cuccinelli files a separate lawsuit in Virginia challenging the constitutionality of the law.
- John Boehner (R-OH) — then the House Minority Leader — promises that Republicans will seek to defund the measure. “You just gotta take appropriated funds to actually come through the process to fund the hiring of new employees, to create these new bureaucracies. I can’t imagine a Republican Congress is going to give this President the money to begin this process,” he tells Fox News.
- Meanwhile, Democratic lawmakers who voted for the bill are receiving death threats and experiencing vandalism. Vandals struck the Tuscon office of Rep. Gabrielle Giffords (D-AZ), the Monroe County Democratic Committee headquarters in upstate New York, Rep. Louise Slaughter’s (D-NY) Niagara Falls office, the Knox County Democratic headquarters in Ohio, and the Sedgwick County Democratic Party headquarters in Wichita, KS. Majority Whip James Clyburn (D-SC), the highest-ranking black lawmaker in the House, has said “he received an anonymous fax showing the image of a noose” and authorities in Virginia are investigating “a cut propane line” at the home of a brother of Rep. Tom Perriello (D-VA).
- Sarah Palin labels a map of vulnerable lawmakers’ districts with crosshairs on her Facebook page and tweeting, “Commonsense Conservatives & lovers of America: “Don’t Retreat, Instead – RELOAD!”
- The ACA prohibits women from using premium affordability tax credits or cost-sharing payments to pay for abortions but also reinforces states’ ability to prohibit insurers from providing any form of abortion coverage within the exchange. The day before Obama sings the Affordable Care Act into law, a Missouri Senate committee votes 5-1 to advance a bill that would deny insurers the right to offer abortion coverage in any government exchange. A total of 23 states now prohibit abortion coverage in their marketplaces.
- Some Republicans are initially wary about repealing the law in its entirety. For instance, in January, Eric Cantor told Politico’s Mike Allen that Republicans “WILL NOT campaign for full health care repeal, but will demand partial repeal, including mandates for health coverage.”
- Rep. Phil Gingrey (R-GA) admits there are portions of the legislation he likes – including the provision that would allow parents to carry their offspring on their insurance until age 26. “When we say start over, we don’t mean throw everything out – throw out the baby with the bath water. We mean, take the best of this bill and combine it with our ideas like buying insurance across state lines and equalizing the tax treatment and creating high-risk pools.” “Of course, all of the language regarding electronic medical records I’m in favor of. So I might not fully agree with completely repealing and starting over.”
APRIL 2010: Republicans actually take credit for parts of Obamacare.
- Republicans admit that repeal is unrealistic. “The fact is that’s not going to happen, OK?” Sen. Bob Corker (R-TN) tells an audience at Vanderbilt University. Sen. Richard Burr (R-NC) agrees: “It may not be total repeal at the end of the day. It may be a series of fixes over the course of this bill getting enacted that allow us to change and possibly bend that cost curve down.”
Rep. Jack Kingston (R-GA) tells a town hall meeting, “There are a lot of things in this bill I think you and I certainly like.” “I think as a practicality you’re going to have trouble repealing the whole deal… there ought to be areas where Democrats and Republicans can come together.”
- John Boehner tries to take credit for some provisions included in the bill and promised to keep them in place.
His refusal to call for a full repeal betrays a growing rift between leadership and the more conservative members of the Republican party. Rep. Steve King (R-IA) —has repeatedly warned Republicans that “if we leave any component of it in there, it has, it’s just become a malignant tumor that’s attacking our liberty and our freedom and it’s diminishing our aspirations and it saps our overall productivity as a nation,” King says. “If we can’t come to that conclusion, then I want some new people to come help me.” In April, repeal legislation had no more than 62 co-sponsors in the House and 20 in the Senate.
- States like Ohio and Alabama approve petitions to remove their residents from requirements to purchase health insurance and to participate in the law’s health plans. The effort was being orchestrated and organized by the American Legislative Exchange Council [ALEC], a “business-friendly conservative group that coordinates activity among statehouses.” The Council is pushing model legislation to protect “the rights of patients to pay directly for medical services” and prohibit the individual mandate. Multiple states pass similar measures, though the effort never proves popular.
MAY 2010: Republicans offer a 9-page alternative.
- Republicans prepare to re-litigate the health care reform debate by blocking the nomination of Donald Berwick, a Harvard University professor, to head the Center for Medicare and Medicaid Services (CMS). The Republican Policy Committee preparesa memo linking Berwick to the British health care system and presents him as someone who supports rationing and a government takeover of health care. Obama recess appoints Berwick in July of 2010.
- Republicans object to government-printed mailers informing Medicare beneficiaries about how the new health care law will improve the program. “This goes beyond propaganda and is blatantly political. If this document is really about Medicare, then why is there information in there about 26-year-olds being able to stay on their parents’ policies?” Rep. Dave Camp (R-MI) asks. “The brochure fails to inform seniors that the president’s new law cuts $550 billion from their Medicare,” Sen. John Barrasso (R-WY) adds.
- Republican leadership in the House introduces a 9-page “bill” to repeal the health care law and replace it with the Republican alternative already defeated on the House floor in November 2009. This is the third repeal bill introduced by the GOP, but the first to replace the law with different legislation. The Congressional Budget Office found that under the GOP alternative, the number of uninsured Americans would increase to 52 million by 2019. The bill could slightly reduce premiums for Americans who purchase coverage independently.
Watch Republicans go at it:
JUNE 2010: Republicans make first effort to repeal the individual mandate, while arguing parts of reform should be better funded.
- Congress rejects a Republican effort to strip the individual health insurance mandate from the new health care law. Twenty-one Democrats cross party lines to vote in favor of the measure, while one Republican, Rep. Joseph Cao (R-LA), votes against it. The effort is led by Rep. Dave Camp (R-MI), who attempts to attach the measure to a motion that would have sent a small business tax credit bill back to committee with instructions to insert language invalidating the measure.
Camp claims that the mandate violated “the basic principle of freedom and individual choice.” “No American should be forced to buy or purchase health insurance they don’t want or can’t afford,” Camp says, arguing that the measure would “uphold the freedom upon which this nation was founded” and obfuscate the need for more IRS agents. Highlights from the debate:
- Florida Senate candidate Marco Rubio — who had signed a pledge to fully repeal the law — tells reports that he would maintain the law’s pre-existing conditions exclusions and the provisions that allow children to stay on their parents’ policies until age 26. “A small group of reporters in a D.C. coffee shop, chatting with Florida Republican Senate candidate Marco Rubio. He just mentioned that there are two parts within the Obamacare legislation that he doesn’t want repealed. The first is the ban on insurance companies denying coverage based on preexisting conditions and the second is that he thinks that children up to age 26 should be allowed to “buy into” their parents’ coverage,” National Review’s Jim Geraghty reported. Rubio later backs away from those comments.
- John Boehner and Eric Cantor sign onto two discharge petitions offered by Steve Kin and Wally Herger (R-CA). The petitions will need to attract 218 members to force the House to take up repeal legislation that would eliminate the entirety of the health law. Herger’s measure would also replace the law with “common-sense reforms.” The move was a significant departure for the Republican leaders who have previously claimed that they would like to preserve the more popular elements of health care reform and repeal “the other” mandates.
- 28 Senate Republicans write to Health and Human Services Secretary Kathleen Sebelius arguing that the law’s high-risk insurance pools “will fail to provide the assistance promised by supporters of the new law.” The office of Rep. Dave Camp (R-MI) put out an entire release complaining about the lack of funds.
AUGUST 2010: Republicans continue to attack HHS education campaigns.
- GOP Senators write a letter to HHS Secretary Kathleen Sebelius expressing their “profound concern” about a television campaign featuring Andy Griffith promoting the health care law. “The Administration’s clam to “correct the record” is misleading and offensive. We can debate the relative merits of the new law, but co-opting public funds during a recession, to make a political, poll tested argument about the new law, is wrong,” the write. Watch the ad:
SEPTEMBER 2010: Republicans go after reform’s regulations.
- Speaking at the Values Voters Summit in Washington, D.C., Newt Gingrich likened Kathleen Sebelius’ warning to insurers against increasing health care premiums exponentially to “Soviet tyranny” and said that a Republican-controlled House should ask for her resignation and defund her office in the Department of Health and Human Services. Watch it:
- Republicans unveil a ‘Pledge To America,’ an agenda which promises to “repeal” all of these benefits — as well as the entire health care law — and replace it with “reforms that lower costs for families and small businesses, increase access to affordable, high-‐quality care and strengthen the doctor-‐patient relationship.” The document provides almost no specifics about what the party would do to control health care spending, improve quality, or pay for its reforms. And at least 7 of the GOP’s ideas on health care are already included in the health care law.
- Sen. Mike Enzi (R-WY) offers a resolution to weaken the law’s “grandfathering” rule, which allows plans that existed before March 23, 2010 — the date the healthcare law was signed — to be exempt from certain consumer protections enacted in the law. Republicans argue that they need to enact the change in order to realize Obama’s promise of “if you like your coverage, you can keep it.”
- GOP Senators began to speak out against regulations on the Senate floor, claiming that “there will be 100 pages of regulation for each page of that bill.” “There are 2,700 pages in that bill. That means there are going to be 270,000 pages of regulation,” Sen. Mike Enzi (R-WI) said. Sen. John McCain (R-AZ) came up with a different estimate, projecting that there would be 121 pages of regulation for every 2 pages in the bill.
- Sen. Tom Coburn (R-OK) predicts that reform would end the health insurance industry. “There will be no insurance industry left in three years,” Coburn tells the Republican Women’s Club of Tulsa County. “That is by design. You’re going to make insurance unaffordable for everyone — which is what they want. Because if there’s no private insurance left, what’s left? Government-centered, government-run, single-payer health care.”
- Many Republican governors are slow to accept federal grants to help implement the health care law. They turn down funds to establish high-risk insurance pools or other programs, arguing that they’d prefer to wait for the Supreme Court to rule on its constitutionality. “Let’s finish this lawsuit and see if the individual mandate gets overturned,” Alaska Gov. Sean Parnell (R) says. “That will directly bare on the health insurance exchanges and we got three years more, four years more until we’ve got to buy into a system that right now, I don’t buy.” However, almost all of the states that sued the federal government over the constitutionality of the law accept some of the early benefits of reform.
- GOP pledge to use committee hearings and “oversight” investigations to build public support for repealing the law. Appearing on Meet the Press Gov. Haley Barbour — then chairman of the Republican Governors Association — predicts that if Republicans aren’t successful in repealing the health care law outright, “they will make such big changes in it over the next three years that you won’t recognize it.”
- Voters in the 2010 midterm elections are bombarded with anti-reform advertising:
70% of voters who saw an Obamacare ad say the ad was in opposition to the Obama plan, 8% in support, with another 20% of voters saying they recall advertising on both sides of the issue.”
- “Opponents of the legislation, including independent groups, have spent $108 million since March to advertise against it” — “six times more than supporters have spent, including $5.1 million by the Department of Health and Human Services to promote the new law.” That $108 million went to finance the claims that individuals who don’t purchase coverage will go to jail, or sex offenders will have access to government subsidized Viagara and seniors will lose all their Medicare benefits.
- After reclaiming the House, Republicans pledge not to fund the health care law. “We don’t have to defund it, we just don’t have to pass the funding for it,” then Sen. Jim DeMint (R-SC) says. “The majority in the House can control the appropriation bills and we can just not include in those appropriation bills the funding for the implementation of ObamaCare. The president may fight us on it and it could be a very intense show down. But Republicans are in a position now to make sure no funding goes forward for Obamacare.” Watch it:
- Senate Minority Leader Mitch McConnell (R-KY) promises that Republicans don’t plan to shutdown the government over reform. “We’re not talking about shutting down the government. What we’re doing here is talking about responding to the American people’s desire that this bill not become law.” Watch it:
- Republicans in the House vote to repeal the health care law, while dismissing a Congressional Budget Office report showing that it would increase the deficit by $230 billion. “I do not believe that repealing the job-killing health care law will increase the deficit,” Boehner said of the score. “CBO is entitled to their opinion, but they’re locked within constrains of the 1974 Budget Act.” Watch it:
Republicans prohibited Democrats from offering any significant amendments to H.R. 2, the GOP’s Repealing the Job-Killing Health Care Law Act and allowed just seven hours of debate on the floor. The measure passed 245 to 189. ‘
- After a federal judge rules that it was unconstitutional for Congress to enact a health care law that required Americans to obtain commercial insurance, a handful of conservative leaders announce that they will stop implementing the measure in their states.
- Michele Bachmann discovers a “bombshell” of $105 billion in mandatory spending included in the health care law. “This is something that wasn’t known,” Bachmann said on Meet The Press. “This money was broken up, hidden in various parts of the bill.” Congressional Budget Office Director Douglas Elmendorf later told Congress the funding was, in fact, widely publicized.
- Sen. Ron Johnson (R-WI) pens an op-ed suggesting that his daughter Carey may have died from a heart condition were she treated under the Affordable Care Act.
- The Republicans on the Energy and Commerce Committee issue a press release in which they claim to have discovered “a $5 billion bailout fund for state governments, Fortune 500 companies, and Hollywood unions.” The program was so secretive that it was extensively covered by the press and regularly touted by Democrats as an example of how the Affordable Care Act would help businesses struggling with growing health care spending and prevent companies from dropping early retiree coverage (seniors 55-64 years old who are not yet eligible for Medicare) before the exchanges begin in 2014.
- Republicans seize on President Barack Obama’s proposal to expand the cost-cutting authority of the Independent Payment Advisory Board (IPAB) — a commission created by the Affordable Care Act to help reduce health care costs in Medicare. “His plan for changing Medicare is to increase the authority and the ability for price controls from the Individual Payment Advisory Board, which is nothing but say we are going to ration care,” Tom Coburn says. “He wants to delegate more power to this IPAB, it’s like 12 people who can’t be controlled by Congress who can just unilaterally ration and price control health care through Medicare,” Paul Ryan adds.
- Sarah Palin may have been the first Republican to argue that her son Trig would be harmed by the Affordable Care Act, but Rick Santorum (R-PA) is not far behind, telling reporters in Iowa that his daughter Bella — who was born with a genetic abnormality — wouldn’t survive in a country with “socialized medicine.”
- With the 2012 election heating up, Republican presidential hopefuls begin attacking Obamacare for its similarity to the reform Gov. Mitt Romney enacted in Massachusetts. Consider this graphic in Rick Santorum’s fund-raising email:
- “The reality is that Obamacare and Romneycare are almost exactly the same,” former New York Mayor Rudy Giuliani would say during an appearance in New Hampshire later that summer. “It’s not very helpful trying to distinguish them. I would think the best way to handle it is to say, it was a terrible mistake and if I could do it over again, I wouldn’t do it.”
- After the administration granted waivers to businesses and policyholders from the Affordable Care Act, excluding those entities from having to offer a minimum amount of coverage annually, Republicans attack Democrats for helping their campaign contributors. “Of the 204 new Obamacare waivers President Barack Obama’s administration approved in April, 38 are for fancy eateries, hip nightclubs and decadent hotels in House Minority Leader Nancy Pelosi’s Northern California district,” the Daily Caller wrote. Newt Gingrich and Tim Pawlenty jump on the story, thought it was later reported that Pelosi had nothing to do with securing the waivers and a government report would later clear the administration of any wrongdoing. Republicans continue to portray the nearly 1,400 waivers distributed by HHS as evidence that the law isn’t working or that the administration is using the process to grant exemptions to and reward its political allies.
- WIth his Medicare “premium support” reforms under attack, Paul Ryan appears on Fox News to argue that it’s actually the Affordable Care Act that “ends Medicare as we know it.” “Millions of dollars of negative ads are being run to try and scare seniors and trying to confuse seniors. You know, the irony of this Bill, is with all this Mediscare that the Democrats are running, it’s Obamacare itself that ends Medicare as we know it.” Watch it:
- Michele Bachmann attacks Tim Pawlenty for endorsing the goal of universal coverage in 2006. “I think it will concern the voters,” she tells conservative talk show host Laura Ingraham. Bachmann adds that it’s important to have candidates who have been consistent on issues like healthcare reform, saying she has been consistent in opposing President Obama’s healthcare law. “We need to have people who have enough foresight and common sense to know these programs aren’t going to work. I’m that kind of person,” she says.
- During an appearance on Fox News Sunday, Pawlenty comes out swinging against Romney’s law. “President Obama designed Obamacare after Romneycare and basically made it Obamneycare,” he says. “We now have the same features, essentially the same features. The President’s own words is that he patterned Obamacare in large measure after what happened in Massachusetts.” Watch it:
- During a primary debate, Pawlenty fails to confront Romney over the similarities of the two plans, effectively ending his campaign:
- The Commonwealth Fund publishes a report examining why enrollment trends in the Affordable Care Act’s high risk insurance pools — temporary coverage programs for uninsured people who can’t find coverage in the individual market — have generally fallen below expectations. Besides the structural challenges, Jean P. Hall and Janice Moore also suggest that the GOP’s efforts to repeal the law may already be undermining the high risk insurance program.
- Conservatives lash out at the Obama administration’s decision to accept the Institute of Medicine’s recommendations and require new health insurance plans to cover birth control with no co-pays. During a floor speech, Steve King adds his voice to the conservative chorus denouncing the very idea of birth control. In apocalyptic tones, King warned that free birth control would “prevent a generation” from being born and make America a “dying civilization.” Watch it:
- Republicans introduce legislation prohibiting the enforcement of any requirement or regulation related to existing health policies, effectively gutting consumer protections for millions of Americans with private coverage. The GOP also offered bill to repeal medical loss ratio (MLR) regulations that require plans that don’t spend 80 to 85 percent of premium dollars on health care costs to issue rebates to their enrollees. Forty-eight national and state consumer advocacy organizations would later release a letter condemning the measures.
- Senate Democrats rebuff “a GOP attempt to attach language to the annual financial services spending bill that would block implementation of a portion of the 2010 health care law.” The Senate Committee on Appropriations “rejected, 14-16, an amendment by Lindsey Graham, R-SC, that would prohibit funds in the bill allocated for the IRS from being used to implement part of the health care law, including the mandate that individuals have health insurance starting in 2014.”
- A group of Republican senators and representatives convene a Senate Swamp to present 1.6 million petition signatures “from American citizens who are urging Congress to immediately repeal Obamacare.” The lawmakers argu that health care reform has undermined job creation and pledged to repeal the law before the Supreme Court rules on its constitutionality in the summer of 2012. Rep. Louie Gohmert (R-TX) went a step further, suggesting that the justices should find the law unconstitutional in order to protect their own medical privacy. “Any president they don’t like will have access to any Justice’s health care records and as I understand — I haven’t read the agreement between the administration and GE — GE will have access to their health care records,” he said.
- “If president Obama is reelected within a year or two he’ll throw his hands in the air and say, ‘it’s not working we have to go to a single payer system,” Sen. Orrin Hatch (R-UT) predicts during a speech at the Heritage Foundation.
- The House Oversight and Government Reform committee publishes a new report arguing that the health care law implements a “marriage penalty tax” that will over time “directly cause fewer individuals to marry.”
- Republicans attack the Obama administration’s regulation requiring employers and insurers to provide reproductive health care services — including contraception — by arguing that the rule is undermining the religious liberties of Catholics and imposing “a secular vision on Americans who believe that they should not have their religious freedom taken away.” The administration eventually announces an accommodation for religious liberties that allows religious nonprofits to avoid providing contraception. The GOP still attacks the new rule as inadequate, suggesting that it is even worse than the original guidelines.
- Democrats tear into House Oversight Committee Chairman Rep. Darrell Issa (R-CA) for preventing women from testifying before a hearing examining the Obama administration’s regulation requiring employers and insurers to provide contraception coverage to their employees. Ranking committee member Elijah Cummings (D-MD) had asked Issa to include a female witness at the hearing, but the Chairman refused, arguing that “As the hearing is not about reproductive rights and contraception but instead about the Administration’s actions as they relate to freedom of religion and conscience, he believes that Ms. [Sandra] Fluke is not an appropriate witness.” Reps. Carolyn Maloney (D-NY) and Eleanor Holmes Norton (D-DC) walked out of the hearing in protest of his decision, citing frustration over the fact that the first panel of witnesses consisted only of male religious leaders against the rule. Issa also dismisses Fluke as a “college student’ who does not “have the appropriate credentials” to testify before his committee.
A picture of the witness table:
- Obama will later poke fun at the hearing during White House Correspondents’ Dinner, joking, “Jimmy [Kimmel] got his start years ago on the Man Show. In Washington, that’s what we call a Congressional hearing on contraception.” Watch it:
- By a vote of 51-48, the Senate agrees to table a Republican amendment offered by Sen. Roy Blunt (R-MO) that would have empowered employers to deny coverage of health services to their employees on the basis of personal moral objections.
- Mitch McConnell tells his conference that he does not want to vote again on repealing the law until after the November elections. In response, the conservative Restore America’s Voice Foundation said it would “unleash” its 2.3 million activists to call for McConnell’s resignation if he didn’t retract his comments. McConnell quickly changes his mind.
- A second House committee — The Ways and Means Committee — agrees to repeal the Independent Payment Advisory Board (IPAB), a 15-member panel tasked with cutting Medicare payments. The Energy and Commerce Committee passed the same repeal bill earlier. The Congressional Budget Office (CBO) finds that repealing the board would increase the national deficit by $3.1 billion and grow health care expenditures.
- The House of Representatives votes to repeal the IPAB by a vote of 223-181. Seven Democrats voted to repeal the board, while 10 Republicans opposed the effort.
- Mitt Romney celebrates the second anniversary of the Affordable Care Act by misrepresenting it, claiming that the Congressional Budget Office concluded that the costs of the law have doubled, cited a discredited study claiming that 30 percent of employers will stop offering insurance as a result of the law, and insisted that the Catholic Church would be required to offer birth control to its employees. All three claims are false.
- The Supreme Court hears oral arguments in the case challenging the constitutionality of the Affordable Care Act. Outside of the Court steps, Texas Rep. Louie Gohmert (R) says that Americans will “die early” if the law remains in place and the Court finds it constitutional. Watch it:
- House Republicans pass legislation that would require families who qualify for subsidies in the health care exchanges to pay higher taxes if their incomes change mid-year. The change could dissuade people from purchasing insurance, disproportionately impact women (who are more likely to experience income fluctuations), and could increase costs for the entire population.
- House Republicans pass a bill preserving lower interest rates on student loans by gutting the Affordable Care Act’s Prevention and Public Health Fund. The GOP measure — which passed in a vote of 215-195, with the support of 13 Democrats — finances the $5.9 billion cost of maintaining the 3.4 percent interest rate on Stafford loans for one year by repealing the Fund in its entirety and rescinding all unobligated balances, including money being spent in 2012.
- The University of Notre Dame, Catholic University of America, the Archdiocese of Michigan, and the Archdiocese of New York have file a lawsuit against an Obama administration regulation requiring employers and insurers to offer preventing health services — including contraception — without additional cost sharing. The suit, one of 12 filed, argues that the requirement violates the Catholic institutions’ religious freedom — even though regulators have included an accommodation for religious organizations.
- Republicans criticize the Department of Health and Human Services for signing a $20 million contract with a public relations firm to educate Americans about the preventive health benefits included in the Affordable Care Act. The campaign — mandated by the law — “must describe the importance of prevention while also explaining preventive benefits provided by the healthcare law,” essentially informing the public about the availability of preventive services without additional co-pays.
- Wisconsin Gov. Scott Walker (R) had promised in January that he would not implement a state exchange program until after the Supreme Court ruled on the Affordable Care Act, but now says he won’t act on the law no matter what the ruling is. Walker says he won’t do anything until after the election in November in the hopes that Romney wins. At least eight governors continue to hold out hope — and postpone implementation — even after the Supreme Court upholds the law.
- The Supreme Court upholds the individual mandate as a tax. The Medicaid expansion is limited, but not invalidated, the court found. In short, it decided that if a state does not expand the Medicaid program, as required by the law, the federal government cannot withhold Medicaid funds. With some news networks erroneously reporting that the Supreme Court struck down the Affordable Care Act’s individual health care mandate just moments after the justices released their opinion, outgoing Rep. Jean Schmidt (R-OH) screamed with joy at the false news that the Court invalidated the requirement. Watch it:
- Republicans immediately announce that they will take another vote on repealing the law the week of July 9th.
- Fox News’s Chris Wallace asks Mitch McConnell how he would provide coverage to the uninsured should they repeal the health care law. After McConnell meandered through the typical GOP talking points that they plan to allow the sale of health insurance across state lines and that they will institute medical malpractice reform, he finally settled on an answer: Insuring Americans “is not the issue.”
- Tom Coburn claims that the Affordable Care Act will “Sovietize the American health care system” because “it means the bureaucrats and politicians are in charge of your health care.” Watch it:
- Following the Supreme Court ruling, Republican governors begin considering refusing billions in Medicaid funds. A ThinkProgress survey finds that ten GOP governors have said definitively that they will not accept the funds, while 19 are still considering other options. Sixteen states, all with Democratic governors, have committed to expanding their programs
- Gov. Rick Perry (R) announces that Texas won’t create a state insurance exchange nor accept expanded Medicaid funds outlined in the Affordable Care Act. In a statement, Perry said, “Neither a ‘state’ exchange nor the expansion of Medicaid under this program would result in better ‘patient protection’ or in more ‘affordable care.’”
- Marsha Blackburn (R-TN) defends the GOP’s 31st vote to repeal the Affordable Care Act, arguing that it is more than “political theater,” and that she wishes they could vote to get rid of Obamacare “every single day.” Watch it:
- Republicans continue to insist that they will unveil their health care reform plan as soon as they repeal Obama’s law. Watch it:
- Republican governors submit a list of questions to President Obama, claiming that they need answers before they’ll consider implementing the law.
- Rep. Denny Rehberg (R-MT) releases a labor, health, and education spending bill to allow employers to deny contraception coverage for “moral reasons.” The measure also stops Planned Parenthood clinics from receiving federal funding until the health organization certifies that it no longer offers abortions, even though Planned Parenthood does not use federal funds on abortion services.
- More than 100 GOP lawmakers ask John Boehner and Eric Cantor to stop “any legislation” from coming to the floor that would fund the implementation of the Affordable Care Act — potentially leading to a government shutdown. Boehner rejects the proposal.
- A Nebraska federal judge dismisses a lawsuit in which Republican attorneys general in seven states tried to block the Affordable Care Act provision requiring contraceptive coverage in employer-provided insurance plans. The seven state officials, along with three Nebraska-based Catholic institutions, filed their lawsuit on grounds that the ACA’s contraceptive provision violates the Constitution’s guarantee of religious liberty by forcing Catholics to pay for contraception against their beliefs.
- Romney selects Paul Ryan as his running mate and begins attacking the Medicare reductions included in the Affordable Care Act. The law reduces future Medicare spending by $716 between 2013 and 2022 and Ryan maintains the savings in his own Medicare proposal. The Romney campaign, however, tries to gloss over the similarity and attack the president for approving reductions that the Republican runningmate also supports. In the days that follow the Romney/Ryan campaign twists itself into a pretzel attacking President Obama for “stealing” $716 billion from Medicare, while trying to explain why Paul Ryan included the savings in his FY 2013 budget:
- Romney even offers a white board presentation during a news briefing in South Carolina that tries to untangle the campaign’s contradictory message about Medicare.
- Between September 1 and October 1, an array of conservative outside groups will spend about $8 million in attack ads, repeating the false claim about Medicare cuts against House and Senate candidates across the country.
- Crafts store Hobby Lobby sues the federal government claiming it should not be forced to provide workers with health insurance that covers the morning-after and week-after pills. The Christian-owned store operates 500 arts and crafts stores in 41 states.
- On election day, five states tack on symbolic measures onto their ballots purely to oppose the Affordable Care Act. Wyoming’s Amendment A, Florida’s Amendment 1, Alabama’s Amendment 6, and Montana’s Measure LR-122 would all prohibit state residents and employers from being forced to purchase insurance or participate in any externally-imposed health care system. In Missouri, Proposition E seeks to prevent the state from instituting its own health insurance exchange.
- Following President Obama’s re-election, Eric Cantor predicts that House Republicans will continue to resist any revenue increases in favor of deep cuts to the social programs during negotiations to resolve the so-called fiscal cliff. Cantor makes it it clear that that this includes slashing funding for health care programs like Obamacare, Medicare, and Medicaid.
- John Boehner confirms that the House GOP will no longer attempt to repeal the Affordable Care Act. Asked about the future of the health care reform law, Boehner says “the election changes that” and “Obamacare is the law of the land.” Boehner does suggest that some parts of the law could “be on the table as lawmakers work toward a balanced budget. However, just moments after making comments, Boehner backpedals, saying that he remains committed to repealing Obamacare. He plater pledges “[v]igorous oversight of the health care law by the House.”
- Though a growing number of Republican governors are implementing parts of the law — including Medicaid expansion — Republicans in Congress are still holding firm. During a Budget Committee Hearing, Sen. Jeff Sessions (R-AL) announced that the Affordable Care Act — which had been projected to reduce the deficit by billions over 10 years — would actually increase long-term debt by $6.2 trillion. Sessions was citing a government report that estimated what would would happen if the cost containment provisions in the law — the Independent Payment Advisory Board, excise tax on high-cost plans, and reductions in Medicare payments to providers — are “phased out over time” while the coverage provisions remain.
- Appearing on Meet The Press, Louisiana Gov. Bobby Jindal (R-LA) advises Obama to put off implementing the Affordable Care Act’s health care exchanges that are due to go online in 2014 and the expansion of the Medicaid program to offset the looming sequester cuts.
- Marco Rubio joins fellow Tea Party favorites Sens. Ted Cruz (R-TX) and Mike Lee (R-UT) in demanding that a continuing resolution to fund the government for the rest of the fiscal year include provisions to defund Obamacare in its entirety. ” I don’t think anyone is in favor of shutting down the government, but I think that’s where we’re headed ultimately here,” Rubio told conservative talk show host Hugh Hewitt.
- A group of top House Republicans write a letter to President Obama asking him to preserve a temporary program included in the law that provides health care coverage to people with pre-existing conditions. The so-called Pre-Existing Condition Insurance Plan (PCIP) was designed as a bridge to the exchanges for families and individuals who don’t have an offer of coverage from an employer and cannot find insurance in the individual market. The $5 billion program, which covers only sick people is incredibly costly, and will soon stop processing new applicants. “Your administration’s action will leave thousands of Americans with pre-existing conditions without access to health care,” the group of House Republicans write. The letter reiterates the GOP’s opposition to the Affordable Care Act as a whole but notes, “to allow PCIP to continue to accept new enrollees, we urge you to support efforts to transfer the funds necessary from other PPACA programs, such as the Prevention and Public Health Fund, the Secretary’s transfer authority to assist with state based exchanges, comparative effectiveness, planning, or another similar program to PCIP.” The GOP would later schedule a vote to shift money from the portion of Obamacare that invests in prevention and use it to expand the temporary initiative, only to pull it at the last minute.
- Freshman House Republicans push for another vote on repealing the health care law, even though they acknowledge the effort is “just symbolic,” so they can tell their constituents they tried to get rid of the law. “The guys who have been up here the last two years, we can go home and say, ‘Listen, we voted 36 different times to repeal or replace ObamaCare.’ Tell me what the new guys are supposed to say?” one member said Wednesday at a forum sponsored by the Heritage Foundation. They will get the opportunity later in the year.
- Four days after news broke that the Internal Revenue Service (IRS) had improperly targeted conservative political groups for scrutiny, GOP Sen. Dean Heller (NV) threatens legislation to “deny the IRS funds to hire new agents to implement Obamacare.” The bill would effectively make it impossible for the agency to provide millions of Americans with federal subsidies to buy the very health coverage they are required to have under the law. Should Heller’s bill become law, the government wouldn’t be able to collect the penalties or pay out subsidies. It would also struggle to capture revenues from fees on medical devises, health care insurers and high-cost plans.
- Sen. Lamar Alexander (R-TN) criticizes Sebelius for asking businesses and other community organizations to support an enrollment campaign spearheaded by Enroll America, a nonprofit organization working to convince people to sigh up for health care coverage. Alexander said Sebelius’ actions should “cease immediately and should be fully investigated by Congress.”
- Marco Rubio proposes a constitutional amendment that, if approved, would nullify Obamacare’s individual mandate. The “Right to Refuse” amendment would make any laws that tax Americans who fail to purchase goods or services unconstitutional, targeting the Affordable Care Act’s stipulation that nearly all Americans must purchase health insurance.
- A new analysis of advertisements about Obamacare aired since 2010 finds that the health law’s critics have spent a whopping $400 million on television spots criticizing the law. That’s over five times the $75 million that the law’s supporters have spent on ads promoting Obamacare and outreach efforts meant to educate Americans about reform.
- Rep. Steve Scalise (R-LA) sends a letter to NBA and NFL league commissioners, probing them about recent talks between the organizations and the Department of Health and Human Services (HHS) on a potential deal to promote enrollment into Obamacare’s insurance marketplaces. “I contend that the effects of this [Obamacare] train wreck will have a devastating impact on your fans and business partners across the country… I would caution you against being coerced into doing [the Obama administration's] dirty work for them,” writes Scalise.
- Mitch McConnell also urges 6 professional sports leagues not to support the law. In letters to the leagues, McConnell and Cornyn cited an announcement by federal Health Secretary Kathleen Sebelius that she is in talks with the NFL, the NBA and others about campaigns to educate the public about healthcare reform.”
- Reps. Tim Huelskamp (R-KS) and Jason Chaffetz (R-UT), announce that their offices would not reply to voters who phoned in with questions about how to enroll in the exchanges or qualify for the subsidies. However, other Republicans — including Rep. Paul Ryan (R-WI) — promise to to aid voters.
- 15 Republicans sign-on to a letter pledging to block a bill to fund government operations unless Obamacare is defunded.
- Officials in Texas and five other GOP-led states are refusing to oversee even Obamacare’s most basic — and popular — consumer protections and insurance market reforms. That includes the law’s ban on denying coverage or charging more because of a pre-existing condition and discriminating against women on the basis of gender. The decision could present major hurdles to Americans who buy health insurance through federally-run marketplaces in the Lone Star State, Arizona, Alabama, Missouri, Oklahoma, and Wyoming. Below is a chart of efforts to sabotage Obamacare on the state level by undermining education campaigns, hampering enrollment efforts, and even outright blocking some of Obamacare’s provisions:
- Republican kick off an investigation into community-based groups who received Navigator grants to help uninsured people enroll in the exchanges established by the Affordable Care Act, demanding that the organizations answer detailed questions and produce thousands of reams of documents. Fifteen Republican members of the House Committee on Energy and Commerce, including Chairman Fred Upton (R-MI), are requesting detailed responses and thousands of pages of documents from approximately 60 percent of Navigator-recipients across the country by Sep. 13. Numerous states have also passed laws regulating navigators.
- Eric Cantor announces that the party won’t support raising the nation’s $16.7 trillion borrowing limit unless President Obama agrees to a one-year delay of the health care law.
- Ted Cruz announces that he will launch a “speaking filibuster” in favor of defunding the Affordable Care Act until he is physically unable to stand. Cruz’s speech is not technically a filibuster, as either way the Senate will vote on the continuing resolution to keep the government from shutting down. Even though the vote will happen regardless of the length of his speech, Cruz vowed when he took the Senate floor, “I intend to speak in opposition to Obamacare, I intend to speak in support of defunding Obamacare, until I am no longer able to stand.” Watch it:
- Unable to reach agreement over Obamacare funding, Republicans shutdown the government while HealthCare.gov opens for business. Users immediately begin reporting long delays, problems creating online account, the website freezing and numerous other glitches.
- Meanwhile, Republicans unsuccessfully try to add the so-called Vitter amendment, a proposal that removes the employer contributions for the insurance plans offered to Congress members and their staff. Without that employer contribution — which currently covers about 75 percent of Congressional staffers’ health costs — the lower-paid staffers on Capitol Hill will ultimately need to seek out government subsidies to purchase plans on the Obamacare exchanges. The measure will essentially amount to a big pay cut, since it will end up significantly hiking their premium costs. Sen. Ron Johnson (R-WI) will later file a lawsuit to prevent Congressional staffers and lawmakers from receiving subsidies.
- With the government re-opens, Republicans turn their political attention to Obamacare and begin holding a series of hearings examining the law’s rocky implementation. Marco Rubio introduces legislation to delay the individual mandate by six months, arguing that Americans should not be penalized for failing to buy coverage they cannot easily access through HealthCare.gov.
- House Republicans portray the website as an insecure portal that will endanger the privacy of American’s medical information during a House Energy and Commerce Committee hearing focusing on the implementation of the Affordable Care Act. The accusations led one Democratic lawmaker to label the hearing “a monkey court.” Watch it:
- Policyholders across the country begin receiving cancellation letters from insurers, undermining President Obama’s promise that you can keep the coverage you have and save thousands of dollars doing so. Next, the NBC News investigations unit reports that “50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a ‘cancellation’ letter or the equivalent over the next year because their existing policies don’t meet the standards mandated by the new health care law” — a fact administration officials knew but kept from the public. Republicans immediately seize on the story and accuse Obama of lying to the American people in order to pass health care reform.
- Lawmakers and the media begin profiling countless middle class Americans who claim that the new health care law will force them to pay more for coverage. The stories are not always accurate, though conservative advocacy organizations will repeatedly try to inflate and in some cases invent victims of the law.
- Obama apologizes to the millions of Americans in the individual health care market who are seeing their policies cancelled, during an interview with NBC’s Chuck Todd, promising to “do everything we can to deal with folks who find themselves in a tough position as a consequence of this.”
- Lawmakers from both sides of the aisle soon introduce different proposals to allow Americans to keep their existing health care plans. Republicans prevent the House of Representatives from considering a measure that would have extended additional consumer protections to beneficiaries who remain in their existing individual health care plans.
- As lawmakers on both sides of the aisle are endorse legislation to allow Americans purchasing health care coverage in the individual market to stay in their existing insurance plans, they ignore a far more pressing coverage problem in the 26 states that have yet to expand their Medicaid programs. There, five million working poor Americans could be denied access to affordable insurance altogether. The failure of some states to expand Medicaid coverage to 133 percent of the federal poverty line, as envisioned by reform, is actually far more disastrous and undermines the promise of health care for the millions who earn “too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits.”
- Paul Ryan and Senate Budget Chair Patty Murray (D-WA) extolled their bipartisan budget deal, which will spare the nation from more government shutdowns over the next two years. But Ryan also suggested that it will help the House GOP’s never-ending attempts to repeal the Affordable Care Act. “We also don’t want to have shutdown drama so we can focus on replacing Obamacare, so we can focus on showing better ideas and what this is coming in. Cause we don’t think people like this law and we don’t think it’s gonna get any more popular,” he says. Watch it:
- House Republicans float a strategy to raise the nation’s debt ceiling for one year in exchange for a repeal of Obamacare’s so-called “risk corridors” — a temporary financial shock absorber that the GOP is misleadingly castigating as an “insurance company bailout.”
- House Republicans are planning to unveil a unified alternative to the Affordable Care Act this spring. Though details of the plan remain sketchy, the measure is “hardly intended as a full replacement of the federal health-care law” and will focus on filling gaps in the health care system. Lawmakers will road test the ideas at town halls, but have no timeline for releasing the alternative.
- House Republicans vote to repeal a part of the health care law for the 51st time.
OCTOBER 2010: “There will be no insurance industry left in three years.”
NOVEMBER 2010: Republicans re-take House in midterm elections.
JANUARY 2011: The first vote to repeal Obamacare.
FEBRUARY 2011: Governors seize on court ruling to abandon implementation.
MARCH 2011: Republicans discover Obamacare bombshells.
APRIL 2011: Vulnerable Americans “wouldn’t survive” with “socialized medicine.”
MAY 2011: Republicans link Obamacare to Romneycare.
JUNE 2011: Obamacare “ends Medicare as we know it.”
AUGUST 2011: Obamacare’s birth control coverage will result in “dying civilization.”
SEPTEMBER 2011: Lindsey Graham tries to block implementation of reform.
OCTOBER 2011: Obamacare will force the nation to “go to a single-payer system.”
FEBRUARY 2012: The contraception wars begin.
MARCH 2012: McConnell says he no longer wants to vote on repeal.
APRIL 2012: Republicans go after prevention.
MAY 2012: Catholic groups sue over contraception requirement.
JUNE 2012: Supreme Court upholds Obamacare, Republicans turn back to repeal.
JULY 2012: More than a dozen governors refuse Medicaid funds following Supreme Court ruling.
AUGUST 2012: Romney/Ryan hit Obama for cutting Medicare funding.
SEPTEMBER 2012: Hobby Lobby files suit to deny contraception coverage to its employees.
NOVEMBER 2012: “Obamacare is the law of the land.”
FEBRUARY 2013: Jindal suggests delaying Obamacare to avoid sequestration.
MARCH 2013: Headed towards a government shutdown.
APRIL 2013: House freshman ask for an opportunity to vote on repeal.
MAY 2013: Republicans seize on IRS targeting scandal to undermine reform.
JUNE 2013: Critics outspend supports of the law 5:1.
JULY 2013: Republicans threaten to block government funding bill.
AUGUST 2013: States refuse to enforce Obamacare provisions.
SEPTEMBER 2013: “I intend to speak in support of defunding Obamacare, until I am no longer able to stand.”
OCTOBER 2013: Republicans seize on the Obamacare rollout debacle.