- 3 weeks ago
The documentary explores the political strategies and compromises involved in the passage of the Affordable Care Act (ACA), also known as "Obamacare".
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00:00Tonight on Frontline,
00:10Your voice can win an election.
00:12He promised change.
00:13Your voice can create the kind of America we dream about.
00:18Then he took on one of Washington's toughest issues.
00:21Let's meet the generation that says,
00:23we will have universal health care in America.
00:25We can do that.
00:27What happened next surprised everyone.
00:30The only way they could get it through was to bribe their members.
00:33Hundreds of millions of dollars spent on lobbying.
00:36Very political, very aggressive at creating deals.
00:39Those deals can be pretty smelly.
00:41Another day, another headache for President Obama.
00:44Is this just the dirty reality of politics?
00:46News of a backroom deal.
00:47In all those backroom deals, it's just wrong and we can do better.
00:51It was a wake up call that President Obama wasn't everything that they thought he was.
00:54The President has staked his entire first term on this.
00:57There's always two sides of Obama.
00:59You have to lift up people, but at the end of the day, it is about deal making.
01:03Tonight on Frontline, Obama's deal.
01:05What's at stake right now is not just our ability to solve this problem,
01:08but our ability to solve any problem.
01:10It's the inauguration day of the nation's first African American president.
01:29It's the inauguration day of the nation's first African American president.
01:33Barack Obama had promised change.
01:36He spoke of no less than remaking America.
01:38His signature issue, universal health care.
01:42In this effort, every voice has to be heard.
01:44This is a huge issue the president is taking on now.
01:47Every idea must be considered.
01:49Everybody loves the idea of health care reform.
01:52Every option must be on the table.
01:54There should be no sacred caps.
01:55The question is, could health care reform really happen?
02:00From the very beginning, even inside his own West Wing, the issue would test President Obama.
02:06The White House had a debate about whether they should actually go forward with it.
02:10No president had ever made headway on comprehensive health care reform.
02:15First it became, let's not do health care.
02:17Then it was scale health care back.
02:19Vice President Biden was opposed to do it, absolutely opposed to doing health care.
02:24Biden had seen too many universal health care programs die in his long time in Washington,
02:28and he warned Obama and his aides not to do it.
02:31The economic team was saying, oh, listen, we've got to spend all our energy on fixing the recession.
02:36We can't launch a big spending program this time.
02:40The president took it all in.
02:42And then it was Chief of Staff Rahm Emanuel's turn.
02:45He's a brilliant political strategist.
02:48Hard-nosed, profane, just a force of nature.
02:53Very political, very aggressive at creating deals.
02:58In fact, probably more so than one would anticipate someone from the Obama administration being.
03:04Obama's choice of an inside dealmaker like Emanuel had surprised many of his supporters.
03:10He's sort of the opposite of Obama in a lot of ways.
03:13It was an immediate indication that this White House was not going to be about kumbaya and getting along and trying to do everything they could to win Republican votes.
03:23They were going to try and win.
03:25Emanuel told Obama to win, he needed to move fast.
03:30He recognized that the moment Obama was going to be at his strongest was the beginning.
03:36In the end, the president decided to go for health care right away, to make a larger point.
03:42We were sitting in the Oval Office as we were sort of having a debate around health care at one point.
03:47The president said, it's about health care, but it's not really about health care.
03:50It's also about proving whether we can still solve big problems in this country.
03:54And this was going to be the test case for that.
03:56In his first address to Congress, the president wasted no time putting health care on the nation's agenda.
04:03Let there be no doubt, health care reform cannot wait, it must not wait, and it will not wait another year.
04:15The president has staked his entire first term on this.
04:19There's no bigger priority than health care.
04:22We can no longer afford to put health care reform on hold.
04:27We can't afford to do it.
04:30At the time, it looked like an easy victory for the president.
04:34Failure to do this would be viewed as a failure to govern.
04:38An inability to use the 60-vote majority that we have in the Senate and the significant margin we have in the House.
04:47I don't think anyone in the White House or on Capitol Hill believe that failure is an option here.
04:54They have to be successful in getting health care reform done, or they'll pay a tremendous political price.
05:00Rahm Emanuel knew about the political price an administration pays when it loses the battle for health care reform.
05:08Sixteen years ago, he worked in the Clinton administration.
05:12The Clinton effort to do health care was sort of a classic smart people will solve your problems approach to an enormously complex, messy political issue.
05:26Bill Clinton delivered a thousand-page plan to the doorstep of Congress after a year and said,
05:32my wife came up with a really good plan, pass it.
05:35At which point, the chairman who'd been there longer than them and were going to be there longer than them basically tossed it aside and killed the bill.
05:41I remember Patrick Monningham, senator from New York, telling me in his very thick Irish accent that he just got this document of 1,273 pages describing how health care reform should be done and basically says, I'm not even going to read it.
06:01The Clinton White House also angered powerful special interests.
06:06The AMA opposed them, the insurance companies opposed them, the doctors across the board, hospitals, you name it.
06:14They were on the other side and the Clinton administration understood that there was little hope that they would ever bring them around.
06:20This was covered under our old plan.
06:23They buried the administration in an avalanche of negative TV commercials.
06:27The government may force us to pick from a few health care plans designed by government bureaucrats.
06:32Having choices we don't like is no choice at all.
06:35If they choose, then we lose.
06:38The Harry and Louise ads cost and cost and cost us in the Clinton years.
06:45It is clear that health insurance reform cannot be enacted this year.
06:51They were handed a devastating defeat.
06:54Emmanuel had seen it all.
06:57Sixteen years later, as President Obama's chief of staff, he would try to do things differently.
07:03What did he do that's different from what Bill and Hillary did?
07:06Everything. Everything.
07:09The great lesson that everyone shared, both folks like Rahm who were there and historians,
07:15is you need congressional buy-in on the front end.
07:18The White House would hold Congress's hand every step of the way.
07:23Obama and Emmanuel had stalked the West Wing with an all-star lineup of former congressional insiders.
07:29He's got Pete Rouse, who served as both Daschle and then Senator Obama's chief of staff.
07:34The head of management and budget, Peter Orszag, was the head of the Congressional Budget Office.
07:38Melody Barnes, who was the head of the Domestic Policy Council, was for years a top aide to Ted Kennedy.
07:45Phil Schallero, who was the top staff guy for Henry Waxman.
07:49In the communications department, Robert Gibbs, who worked in the Senate, who's now the press secretary.
07:53So they had a very, very strong team of people who knew the Hill, knew how to work the Hill, knew how to have success on the Hill.
08:00And to run it, they brought back the quintessential Washington insider, former Senate Majority Leader Tom Daschle.
08:08It was an enormous signal that this really is a priority for the administration.
08:14They're not messing around, they're bringing in the pros, they're bringing in the big guys to get this done.
08:21Obama decided he would stay in the background.
08:25He would encourage Congress to come up with a plan.
08:28Fast-track it, relying on goodwill and personal relationships to get it passed.
08:35But the idea of hiring insiders almost immediately hit a snag.
08:40ABC News has learned of problems faced by another of President Obama's cabinet choices.
08:46Tom Daschle, the president...
08:47Tom Daschle is trying to save his nomination to become president.
08:50An unwanted distraction for the Obama administration.
08:52I think that just shows a problem with integrity, and we cannot afford that in our government right now.
08:58A once-powerful Senate Majority Leader had made enemies.
09:02The Finance Committee Chairman, Max Baucus, a Democrat from Montana, was an old rival.
09:07Daschle was not helped by the fact that Max Baucus was not necessarily a close friend or ally.
09:16Baucus allowed Republicans on the committee to tear into Daschle's personal finances.
09:21You had a very rigorous Senate Finance Committee staff that was scrubbing the tax returns of the nominees that were going through that committee.
09:31That's unlike anything that I think we've seen in many years.
09:35Senate investigators found income tax problems.
09:39Daschle had left the government and cashed in, making millions at a Washington law firm.
09:45Along the way, a client had provided a limo for Daschle's personal use.
09:50Eventually, he paid more than $140,000 in taxes and penalties on the gift.
09:56To this day, I think there are people in the greater Daschle universe who say that the reason that Tom Daschle did not make it through the confirmation process is because Max Baucus gave him such a hard time dragging out the confirmation and the details and all the financial disclosures.
10:12There is plenty of drama in Washington at the moment.
10:17Republicans talking about limousine liberals who don't even pay taxes on their limousines.
10:21It's a very bad cloud over this nomination.
10:24It's disheartening, obviously. It frustrates me.
10:27Does this really represent the kind of change that Mr. Obama said he would be bringing to his administration?
10:32Daschle had been around long enough to know he had become a liability for the new president.
10:37Obama quickly, calmly accepted the resignation offer, did not pause, did not look back.
10:50He'd campaigned as a political outsider, but surrounded himself with insiders and watched as one of them was taken down in a political knife fight.
11:05Seven weeks into his presidency, in March of 2009, the new president gathered in one room at one time, friends and potential enemies alike.
11:19You're talking about lawmakers, doctors, nurses, hospitals.
11:23Bringing together lawmakers and interest groups.
11:25Cabinet officials, members of Congress, the White House team conferring on how to overhaul health care.
11:31I know people are afraid we'll draw the same old lines in the sand and give in to the same entrenched interests and arrive back...
11:38Many of these players, for years if not decades, had a record of opposing any sort of health care reform efforts.
11:47Rahm Emanuel engineered this strategy.
11:50Everyone remembered how special interests had sabotaged the Clinton plan.
11:55They want to get people onto the table.
11:57They don't want this to be, at first at least, a fight against the insurers, a fight against the medical industry.
12:03They want the pharmaceutical industry.
12:05They want to get buy-in.
12:06I'm going to switch gears and get some groups in here.
12:08Obama's advisers had told him that many of the lobbyists in the room were prepared to cut a deal.
12:13Karen Ignani is the chief lobbyist for the insurance industry.
12:19We entered this year being committed to change, being committed to restructuring, and committed to actually helping to get this done.
12:28We hear the American people about what's not working.
12:30We've taken that very seriously.
12:32You have our commitment to play, to contribute, and to help pass health care reform this year.
12:37Good. Thank you, Karen. That's good news.
12:39That's America's health insurance plans.
12:41This was really astonishing.
12:46Here she was, on record, saying we're going to help you, and so too were the drug companies.
12:52Karen Ignani wanted to be sure that she was at the White House representing the industry in the most positive way that she possibly could.
13:00It was part of the industry's charm offensive, as I call it.
13:04The industry knew that it was going to be under attack this year, or at least the legislation would focus very heavily on the insurance industry.
13:13And, you know, look, I mean, they could read the political tea leaves.
13:16You know, the saying in Washington was, you can be at the table or you can be on the menu.
13:22Privately, Ignani was playing hardball.
13:25She said she'd support the bill only if everyone was required to buy health insurance.
13:31They said for the first time they would support universal coverage, with one caveat, and that is that we have an individual mandate requiring people to buy insurance,
13:40so it's not just the sick that buy insurance, but everybody.
13:45That was the quid pro quo.
13:47Obama had campaigned against the mandate.
13:50Ignani was insisting he reverse himself.
13:53They want to make sure that they get a requirement that all of us buy health insurance.
13:59They want to make sure that we are all forced to buy products from them.
14:03And they want to make sure that there's no alternative other than the private insurance market.
14:08That's why they're so adamantly opposed to the public option.
14:12Obama had also supported the public option, a government health plan.
14:17And Ignani wanted him to walk away from that, too.
14:20It is not wiping out the private insurance industry.
14:23It's just creating a public insurance plan that would compete with private insurers.
14:28But they wanted no part of that.
14:30Emmanuel would keep Obama away from direct deal-making with Ignani.
14:35But with Tom Daschle gone, and health care's most powerful advocate, Ted Kennedy, dying of cancer,
14:41the negotiations would have to be handled by that powerful chairman of the Senate Finance Committee, Max Baucus.
14:48Who do they get after losing Tom Daschle and, largely, Ted Kennedy? Max Baucus.
14:58Not the first choice of most of the people in the West Wing.
15:03He's not glamorous. He's one of the senior-most senators.
15:06Very few Americans know anything about him.
15:08He's from Montana, a more conservative Democrat than a lot of the people in the White House,
15:13worked with the Bush administration on things like tax cuts and issues that are anathema to a lot of the liberal base.
15:19Cutting deals with health care industry groups was right down Max Baucus' alley.
15:24In 2008, during his re-election campaign, which is really when this debate began,
15:29he raised well over a million dollars only from the health insurance sector.
15:34That's a pretty astounding amount for somebody who's going to have a central role in this debate.
15:41In all, Baucus received more than two and a half million dollars from special interest groups in the health industry.
15:49What the campaign contributions often do is that they open doors.
15:54They give industry's entree to important congressional staffers and lawmakers.
16:02Privately, Ignani pushed Baucus for a bill that would include the mandate to buy insurance and kill the public option.
16:10That didn't sit well with the president's liberal supporters.
16:14The Senate bill, you know, frankly, is just an insurance company bill.
16:18The insurance companies actually literally did write it.
16:21There were two senior staffers in Max Baucus' office,
16:24one who used to work for UnitedHealthcare and one who used to work for WellPoint, who wrote the bill.
16:28It's a great bill from the insurance company's point of view.
16:31It doesn't happen to do a whole lot to change the system and to bring reform.
16:37The left counterattacked at a hearing in May.
16:40We're going to take you live to a Senate Finance Committee hearing looking at health care.
16:45We'll come back to Ireland.
16:48Liberal outrage arrived in Baucus' own hearing room as health care activists, one after another, shouted him down.
16:55We're going to take you live to a table discussion.
16:56We're going to take you live to the insurance industry, the HMOs, the pharmaceutical companies, and you're denying the people a voice.
17:09We want a seat at the table.
17:11Why are their voices not being heard?
17:14Every healthcare lobbyist in America is at the table.
17:18The activists were especially angry that Ignani had a seat at the table, but they did not.
17:24When we received the list of the dates of the hearings and who was being invited and we saw who was invited,
17:31we requested that we have one person invited in the series of the three hearings.
17:37They were inviting 41 people total to testify, and they said no.
17:42The committee will stand in recess until the police can restore order.
17:47I thought Senator Baucus did a spectacular job of handling that, not getting rattled in any way, handling it in not only a very professional but an empathetic way.
18:00Baucus himself declined to discuss his role with Frontline.
18:04Five people were arrested at a Senate Finance Committee hearing on healthcare reform and charged with this.
18:09So what Chairman Baucus has decided this option cannot be part of the discussion at a Senate hearing?
18:17I think that's wrong. I don't think it's fair. I think it's...
18:21That spring, Baucus and the White House were also secretly negotiating another deal, this time with the pharmaceutical industry.
18:30Their top lobbyist was a classic Washington character.
18:34Billy Towson is a New Orleans politician, very colorful, lively figure who took over the pharmaceutical industry trade group, Pharma.
18:47Billy Towson is a formidable negotiator, and Billy Towson knows how things work on the Hill, and he knows how things work in this town.
18:56His most notorious act took place when then-Congressman Towson and Senator Baucus pushed through a Medicare prescription drug bill.
19:05We're about to pass a $400 billion insured drug account for these citizens, who have no drug insurance today.
19:13In 2003, in the middle of the night, Towson kept the House voting machine open until he could scrounge and wheedle just enough votes to pass the controversial measure.
19:24It was a payoff to two industries, the drug industry and the insurance industry. There was no question about it. They did very, very well out of this bill.
19:31It meant hundreds of billions of dollars for the pharmaceutical industry.
19:36The comptroller general said when we passed the Medicare prescription drug bill that it was the worst piece of legislation fiscally that he had ever seen.
19:45And he said over time it was going to be a disaster.
19:48It continues to be a classic Washington story of money and behind closed doors maneuvering.
19:55It made Towson's reputation.
19:57You know, the smart money is always going to be on Billy Towson in a negotiation because he knows what he's doing.
20:03And just over a year later, Towson was hired as the pharmaceutical industry's top lobbyist.
20:08Billy got a very good job with pharma. I think he makes around $2 million a year, at least that's what I've been told.
20:15Many of his staff people went with him or went to work for pharmaceutical companies.
20:21And Billy was the main pusher of the bill.
20:26I'm Barack Obama and I approve this message.
20:28In the 2008 presidential campaign, the incident became one of Barack Obama's favorite complaints about the Washington political culture.
20:36You know what? The chairman of the committee who pushed the law through went to work for the pharmaceutical industry making $2 million a year.
20:45Imagine that.
20:46Imagine that.
20:47That's an example of the same old game playing in Washington.
20:51You know, I don't want to learn how to play the game better. I want to put an end to the game playing.
20:55But secretly, one year later, at Max Baucus' Senate office, the Obama White House was negotiating with Billy Towson.
21:05It's a very Rahm Emanuel idea. Get them at the table, make them agree to something with a threat that something worse could be out there if they don't.
21:12And once you get this buy-in, that should eliminate pockets of opposition.
21:17Billy Towson knew that during the presidential campaign, Barack Obama had promised to slash drug prices.
21:24Pharma had some real concerns that there would be an effort by the Democrats to enable the government to negotiate for its prices on Medicare prescription drugs.
21:36And this could be a potentially very big hit to the industry.
21:39Towson also knew the White House was eager for any early deal that appeared to contain costs.
21:45I think he was smart in saying that if I get in early, I can make a deal that my members can live with.
21:54He proposed a complicated formula which he said would cut drug costs by $80 billion over 10 years.
22:01White House aide Jim Messina took the deal to the Oval Office.
22:05Emanuel and Obama believed there was an implicit threat attached.
22:09If they didn't agree to the deal, Billy Towson could do real damage.
22:14From the point of view of Obama and the Finance Committee, huge advantage to have this interest group on your side.
22:21Pharma certainly had deep enough pockets to do some real damage, advertising-wise, if it wanted to.
22:31If you can stop $100 million from being spent to attack your plan, that looks very, you know, that's not such a bad deal.
22:40But taking the deal meant the President would back off his campaign promise to dramatically cut drug prices.
22:47We talked about it. It's always been my practice not to reveal conversations I've had with the President or people in the White House.
22:57Tom Daschle continued to visit the Oval Office in an unofficial capacity.
23:02The President saw it as an opportunity to seize the moment, you know, to get signatures on the line, to say, this looks like an opportunity we haven't had before.
23:12So let's lock them in to the extent we can. I'm going to seize the moment.
23:16They brought stuff to the table and were willing to work with us, and the President said that having people at the table is better than having them throwing stuff at the table.
23:25But not an easy thing to do?
23:26No, certainly not. Certainly not. And went in with full eyes open that there were going to be people in our party who would be critical of that.
23:34The President accepted the deal.
23:37There's always two sides of Obama.
23:39You have to have this sort of inspirational message. You have to have something to lift up people.
23:44But at the end of the day, when you're passing legislation, it is about deal-making. There's no other way to do it.
23:50In June, the President announced the broad outlines of the pharma deal.
23:55Good morning, everybody. Good morning.
23:59He did not mention what he had given up to get it.
24:02This is a significant breakthrough on the road to health care reform, one that will make the difference in the lives of many older Americans.
24:12It didn't take long for the secret to leak.
24:15Another day, another headache for President Obama.
24:19I mean, is this just the dirty reality of politics?
24:21News of a backroom deal riled fellow Democrats.
24:25Once again, it was the liberals in the President's own party who began to criticize the deal.
24:30There's also growing concern that the Obama administration secretly made concessions to drug companies.
24:35The liberals were watching what was going on with increasing alarm because what they saw was the new White House getting in bed with the people that they thought they had been fighting against for all these years.
24:47Obama's rewarded the drug companies in a big way.
24:49What did the pharmaceutical industry get in return?
24:52I think people who thought that the pharmaceutical industry was still reaping profits that were excessive were unhappy with that deal.
25:00And were particularly unhappy that it got cut behind closed doors.
25:05It was a wake-up call, really, to a lot of liberals that President Obama wasn't everything that they thought he was.
25:12For months, the President had been doing deals, insurance and pharmaceuticals.
25:18Now it was time to write a bill, and to fulfill another campaign promise, to create a Washington beyond partisan politics.
25:27A bipartisan outcome, even in a minimalist sense, was certainly a very, very high priority of President Obama.
25:35Again, Max Baucus would have to be the point man.
25:39Getting through his Senate Finance Committee would be the crucial test.
25:44If they could get five, ten Republicans, that would have been enough.
25:48And Max Baucus was, they thought, their key to getting that.
25:51Baucus had a close relationship with the ranking Republican, Chuck Grassley.
25:56Senator Baucus and I were still working on what we thought ought to be a, not just a bipartisan bill, but a kind of a consensus bill.
26:05In other words, something that would get 75 or 80 votes.
26:08But others said they saw nothing for the Republican Party in Baucus's proposals.
26:13I found myself coming out of those secret meetings, those private meetings, and criticizing virtually everything they were doing.
26:20So I talked to Max, I talked to Chuck Grassley and others, and said, look, I don't think I can support this.
26:26And from the beginning, Grassley was under intense pressure from his own party.
26:31Charles Grassley is in line for committee chairmanship.
26:34The Republican Party plays hardball with its members.
26:37I think the message got through that he was jeopardizing his standing in the party by playing too nice to healthcare reform.
26:44It became clear that the Republican game plan was going to be just to say no, to deny this president any victories.
26:54There was enormous pressure from the Republican leadership.
26:57They did not want to be part of this. They did not want to make a deal. The word went out.
27:02You have the Senate leadership in Mitch McConnell and John Kyle saying, don't get involved. This is going to be the president's Waterloo. It's our way to win back the Congress.
27:11And as the summer wore on, winning Grassley over became harder and harder for Baucus.
27:17The process, particularly in the finance committee, just felt like that race that was being run starting on January 20th all of a sudden hit some mud and people's shoes got pretty soggy and pretty heavy.
27:32Everything kind of bogged down. I mean, here we were on this march to produce this bill and at least get it through the House floor before the August recess and all the wheels came off.
27:42Impatient, Emmanuel began a campaign to convince the president to change course, to scale back their ambitions.
27:51Rahm Emanuel is all about, as he says, putting points on the board. Just get a deal and get it over with.
27:58Rahm was the guy who was skeptical about trying to go for major comprehensive healthcare reform. He saw what happened. He was there during the Clinton debacle. He knows how much it takes out of a presidency.
28:10It was entirely a conversation of feasibility. Option A, pass the comprehensive bill. Option B, smaller bill. And option C, which no one would entertain would be to do nothing.
28:22The president made the final decision.
28:25Obama weighed in and said, no, I want to try and get what I campaigned on. I want to try and get the full bill.
28:32But Congress was in no hurry. Some members of Congress telling the president to slow down. Don't push so hard.
28:39They don't like timetables over there at the Finance Committee, Rick.
28:42By August, as Congress headed home for the summer recess, there was still no bill. Some in Washington wondered whether healthcare reform could survive the recess.
28:55Well, heading into the summer recess is a period of great frustration for the White House. Everything was getting stuck. Everything was sort of slowing down.
29:05And as they head into August, they don't recognize what's about to hit them.
29:17You want to kill my grandparents? You come through me first!
29:20God will take care of healthcare.
29:22Yes, we can! Yes, we can! Yes, we can!
29:25We can't afford it!
29:26Afro-Leninism!
29:28Angry citizens, stoked by economic fears, outraged about bailouts and expanding government.
29:35The things that Obama's doing are the exact things that Hitler did.
29:40No public option!
29:42Focused their rage on the healthcare bill.
29:44Boom, the summer town halls literally blow up in our faces.
29:49Radical, communist, and socialist.
29:52The fat really hit the fire when we went home in August for what usually is a fairly leisurely stroll through the district.
30:00Yes, we can! Yes, we can! Yes, we can! Yes, we can!
30:04To town hall here.
30:05Baby killer, abortion is murder!
30:09Summer parade there, and ice cream social here.
30:12No, it was all healthcare all the time, and people were red hot about it.
30:18It was a radioactive issue all summer.
30:20We won't wait for murder!
30:21The surprise is just how out of hand these town hall meetings are getting.
30:25There is an ugliness with these fringe people who are comparing the president to Hitler.
30:30This opposition was real, and this opposition rose up, and this opposition let individual members of Congress from across the country know that they had problems with this healthcare plan.
30:41In that first week of August, the anger was spilling out.
30:45It was spilling out so much that guns were spilling out of people's coat pockets at town hall meetings.
30:50I'm not a lobbyist with all kind of money. The stuff in your pocket...
30:55And I think that the members themselves were a bit taken aback by the intensity of that anger.
31:00And the rest of your damn cronies up on the hill!
31:04There was anger out there, and members of Congress listened, and they were scared.
31:09We had this horrible backlash.
31:11I mean, there were moments in August when it looked like it was done.
31:14This was the end of healthcare reform.
31:16Senator Grassley, the swingman on the president and Max Baucus's bipartisan strategy, felt the fire from his conservative base.
31:26I had people come to my town meeting with sheets of paper that thick off the internet and quoting from the bill.
31:33You know, I've never had that happen before.
31:35People were up on it, and people didn't like what they were reading.
31:38Democrat or Republican, for whoever, Senator or Congressman, vote for this bill, we will vote you out.
31:45Suddenly, the idea of cutting a deal with President Obama no longer looked like it was good politics, no longer like it was good policy.
31:51There's a bill out of the House of Representatives put together under Speaker Pelosi,
31:55Speaker Pelosi's leadership.
31:57I'm...I'm...I'm...I'm...I would not vote for that.
32:06There's...
32:08It's not a profile in courage.
32:10It's someone who becomes convinced that healthcare, if he supports it in any version,
32:16will, you know, end his career politically down the road.
32:20Thank you all very much for coming.
32:23Once they sort of lost Grassley, they lost, arguably, their last chance to really get a bipartisan bill.
32:31Kill the bill! Kill the bill! Kill the bill! Kill the bill! Kill the bill! Kill the bill! Kill the bill! Kill the bill!
32:40Just as the town hall anger was reaching its boiling point, the president received more bad news.
32:48Senator Edward Moore Kennedy, the patriarch of the Kennedy clan, has died.
32:54The last in the line of this extraordinary American dynasty, is gone.
32:59Last night, an American political era came to an end.
33:03The most passionate advocate of healthcare reform was dead, but some believed Kennedy's death might change the tone of the debate.
33:21Ted Kennedy's life work was not to champion the causes of those with wealth or power or special connections.
33:30It was to give a voice to those who were not heard.
33:33It was an emotional rallying point for Democrats for a while, win this for Teddy kind of thinking.
33:42Some people thought, well, gosh, maybe in memory of Senator Kennedy, some of these old Republican friends of his would rejoin the effort.
33:54The president would redouble his efforts to achieve Kennedy's dream.
33:59After consulting with a number of people, including Senator Daschle and others, I think the president concluded, I need to take back control of this.
34:09Madam Speaker!
34:11The President of the United States!
34:13They know that their most powerful tool is Barack Obama, always has been, probably always will be.
34:25His audience really in that speech wasn't the public in general, it was the people sitting in that chamber.
34:31The time for bickering is over.
34:34The time for games has passed.
34:37Now is the season for action.
34:40Now is when we must bring the best ideas of both parties together and show the American people that we can still do what we were sent here to do.
34:50It was an attempt to sort of recapture the high ground.
34:53It was an attempt to, you know, bring the debate back to a loftier level.
34:58More security.
34:59But the tone immediately sunk to a new low.
35:02There are also those who claim that our reform efforts would ensure illegal immigrants.
35:07This, too, is false.
35:10The reforms, the reforms I'm proposing would not apply to those who are here illegal.
35:17It's not true.
35:22A lone congressman says, you lie.
35:25You lie!
35:28It was Republican Representative Joe Wilson from South Carolina.
35:32It crystallized this moment in Washington.
35:36It crystallized the anger.
35:37It crystallized the fervor of the opposition.
35:41I was in the chamber when the speech was being given,
35:45and there was a gasp on both sides of the aisle.
35:48I was upset with that.
35:50That was inappropriate.
35:52I was sitting there and I thought, what in the world?
35:55Why would anybody do something like that?
35:58An outburst that continues to reverberate across the country.
36:03Totally disrespectful.
36:04No place for it.
36:05He is lying.
36:06President Obama is from the moment he opens his mouth until he ends the speech.
36:10How did we get to a point where it's okay to yell, you lie, at the president while he's speaking to Congress?
36:17The effort to forge a bipartisan agreement was for all practical purposes over.
36:23Now the president would turn to the Democrats.
36:26They pressured Max Baucus.
36:29Emanuel wanted a bill, ASAP.
36:34They just ignored Max in the end.
36:37They just felt they could ram this right through and to heck with Republicans, to heck with conservatives.
36:44I don't think that Rahm Emanuel ever worried much about bipartisanship.
36:49He was focused on winning.
36:51Senate Majority Leader Harry Reid would take control of the bill.
36:56Talk of a public option was back.
36:59The mandates the insurance industry had fought for were watered down.
37:03Karen Ignani didn't like what that might mean for the bottom line.
37:07I was concerned about what we were seeing from our actuaries, what we were seeing from our economists.
37:14We were very concerned about what was happening.
37:17And the insurance companies at that point decided, we've got to fight back on this.
37:21America's health insurance plan said the finance bill could result in dramatically higher insurance premiums.
37:27The insurers are trying to scuttle the health care bill.
37:30White House officials today said they feel broadsided.
37:33At the White House, they decided a war with the insurance industry was just what the doctor ordered.
37:40In his weekly Internet address, the president let them have it.
37:44The insurance industry is rolling out the big guns and breaking out their massive war chest to marshal their forces for one last fight to save the status quo.
37:54It's always great to have the enemy in politics. There's no question about that.
37:57However, we didn't pick the insurance companies as the enemy.
38:00They decided to play that role when they decided to spend tens of millions of dollars to defeat health reform.
38:06They're flooding Capitol Hill with lobbyists and campaign contributions.
38:10And they're funding studies designed to mislead the American people.
38:13I have a hearing disability. I wear a hearing aid. And I didn't have my hearing aid in.
38:18And I thought to myself, this can't be true. I ran around looking for my hearing aid.
38:23Because I was sure that I was mishearing, not hearing it correctly.
38:27It's smoke and mirrors. It's bogus. And it's all too familiar.
38:31Karen Ignani and her allies fought back.
38:34New hidden taxes that Congress wants on your health care.
38:39Hidden health care taxes on medicines, medical devices, and health insurance.
38:45They secretly funneled millions of dollars to a tough ad campaign by the Chamber of Commerce.
38:50Call Congress. Tell them no hidden health care taxes in a recession.
38:56And powerful senators stepped up to support her cause.
39:00There were still some. Senator Lieberman was one.
39:03Senator Nelson of Nebraska was another.
39:06Who still said, there's merit to what the insurance industry is saying.
39:11And those were critical swing votes.
39:14Emanuel and Harry Reid were now doing deals just to win over Democrats.
39:19They killed the public option, pleasing Senator Lieberman and others.
39:24They lowered proposed taxes from medical device makers for Evan Bayh.
39:28The final holdout was the Democrat from Nebraska,
39:32former insurance executive Ben Nelson.
39:35Ben Nelson is one of the more conservative members of the Democratic caucus in the Senate.
39:39And they needed his vote. They had to have his vote.
39:42That meant sitting down and hammering out a deal,
39:47really giving him almost what he wanted, anything he wanted.
39:51The focus at the end in a bill like this is always on how do you get those last two or three votes.
39:56And compromises are made and thrown at senators' feet in order to get them to vote.
40:00In Nelson's case, the cost was $100 million.
40:05The costs of expanding Nebraska's Medicaid would be covered by the U.S. taxpayers.
40:10To a lot of us, we were very, very upset about it.
40:13It was very poorly done, but the only way they could get it through was basically to bribe their members.
40:19The press called it the Cornhusker Kickback.
40:23Nelson promised a vote for health care reform.
40:27Prostitution has been legalized in Washington, D.C.
40:31Is this deal for Ben Nelson forever and ever, amen, forever and ever, and only for Nebraska?
40:38I think it stinks. I think it's sleazy.
40:41This isn't sleazy. This is gangster.
40:44You've got to compliment Ben Nelson for playing the prices right.
40:48It's not a pretty process. There is deal making. That's the way it's been done for a long, long time.
40:55But those deals done in your front parlor can be pretty smelly.
41:00The public was already up to hear with what they were seeing in Washington, and I think it just put them over the side.
41:07That was very sour stuff to most people in this country.
41:10They realized that this is not the way to legislate.
41:15Mr. McConnell, no.
41:18Mr. Menendez, aye.
41:20The Senate convened to send President Obama a hard-fought Christmas present.
41:24Ms. Murkowski, no.
41:26It's first roll call vote on Christmas Eve since 1895.
41:30Mr. Nelson of Nebraska, aye.
41:33The yeas are 60, the nays are 39, H.R. 3590 is passed.
41:40Tonight, the ayes have it. The Senate passes an historic health care bill.
41:46Undoubtedly, Dan, this was a strictly party-line vote. All the Democrats voting yes. All the Republicans voting no. The final tally, 60 to 30.
41:55Christmas morning, everyone was sitting around thinking that he was an LBJ-like genius because it appeared that he was on the verge of accomplishing what no president had for 70 years.
42:10They were so close. They were inches away from getting this bill.
42:15They had 60 votes on record in the Senate. They had the House bill in hand. The Emerald City was right there in the distance.
42:26The White House wasn't paying attention. But up in Massachusetts, that Cornhusker kickback was still hanging in the air.
42:34It was almost election day. At stake was Ted Kennedy's Senate seat.
42:39The polling numbers are all over the place. This could be a breakthrough for the Republicans.
42:44I think the headline in the Boston Herald this morning says it all. Mass hysteria.
42:49Hey, how are you? This is Ellie Kwan from the Scott Brown campaign.
42:53A political newcomer was on the verge of taking a seat the president was counting on to pass health care reform.
42:59Republican Scott Brown is riding the wave.
43:05Brown's campaign language has the aura of a revolutionary crusade.
43:09Business as usual is not the business we like. And all those backroom deals from Nebraska and others, it's just wrong and we can do better.
43:18Scott Brown effectively used that as a way of saying that change has not come to Washington.
43:26The Democrat, Martha Coakley, was sinking in the polls.
43:32Only belatedly does it dawn on the White House what's about to happen.
43:36The president's not going to go up there to campaign for her until the Friday before the election when Martha Coakley calls David Axelrod personally and says, I need him to come up.
43:45President Barack Obama.
43:49They frantically sent Obama up to Massachusetts the weekend before.
43:55He makes very clear to the Massachusetts electorate what's at stake here is the Obama presidency.
44:00And do they want to hand the Republicans the power to stop his agenda on health care and on everything else?
44:08By election day, the president knew they would lose.
44:14January 19th, 6.30 p.m., about an hour and a half before the polls close in Massachusetts, Obama calls for Pelosi, Reid, Biden, and Rahm Emanuel to come to the Oval Office.
44:29They immediately convened an emergency meeting.
44:32From the very moment that it was clear that Scott Brown was going to win that seat, he began thinking through what the next steps would be to be able to right the ship and get health care done.
44:43The president asked Speaker of the House Nancy Pelosi if she could get the House to pass the Senate bill.
44:50Pelosi is annoyed and quite adamant that there's no way she can sell that to her House members.
44:58Almost kind of lecturing, saying, you don't understand the realities in the House. This won't work.
45:05And Obama finally snaps, uncharacteristically for him, and he says, I understand that, Nancy. What's your suggestion?
45:15And there is no suggestion.
45:18We went from basically beginning to plan how and when the president would sign the bill to if we could even resuscitate the bill.
45:27Scott Brown is the winner of the Massachusetts-United States Senate race.
45:37Brown's victory shakes up Massachusetts and it shakes up the nation.
45:42USA! USA!
45:44Republican taking over the seat that Ted Kennedy held for 46 years.
45:49USA! USA! USA!
45:51Here he is, the United States Senator from Massachusetts, Scott Brown.
45:56People do not want the trillion dollar health care plan that is being forced.
46:01In one election was a composite of all that ill feeling from the grassroots of America.
46:13And if it can be expressed in liberal Massachusetts, they know it's a lot worse in Montana and Wyoming.
46:20If they replace the so-called Kennedy seat with a Republican, then my gosh, you better wake up.
46:30The president's supermajority was gone.
46:33The Republicans now had their 41st vote.
46:39The worst blizzards in history buried Washington in February.
46:45But getting a health care bill passed now looks more difficult than ever.
46:50All of the options for health care get very ugly.
46:53It closed the government.
46:56I don't see any way you go forward from here with health care.
47:00They're shell-shocked.
47:02They're going to need a whole new strategy on health care reform.
47:04Barack Obama was coming to terms with what looked like his first significant failure as president.
47:11This is a complex issue.
47:14And the longer it was debated, the more skeptical people became.
47:19I take my share of the blame for not explaining it more clearly to the American people.
47:24The process was messy, and so it turned people off.
47:29It ended up being behind closed doors.
47:30It was filled with a lot of partisan wrangling, people yelling at each other across the table.
47:36We ended up having a process that represented a lot of what the American people hated about Washington.
47:42The president is in some ways kind of rebalancing himself.
47:47The year had been very hard on him.
47:50The Massachusetts defeat symbolically was terrible and practically had a devastating effect.
47:55The president admitted he's made some mistakes in his first year in office, but said he won't win.
47:59The chastened U.S. President Barack Obama concedes he's made some mistakes in his first year in office.
48:05He's got an uphill fight here.
48:08While the country waited, Obama formulated a new plan.
48:16He would personally sell the bill to Congress and the American people.
48:19The president said to us that he would do anything.
48:23He will call anyone, meet with anyone, he will speak anywhere, he will do whatever it takes to make the case.
48:29He was going to have to be the primary spokesperson for health reform.
48:33He was going to have to force action.
48:36He deployed Rahm Emanuel to work with Speaker Pelosi.
48:41They would try to get enough Democrats on board to push through the Senate bill.
48:46They realized that their political operation had come way off the tracks.
48:50And they needed to quickly right that operation.
48:56They began their comeback by staging a showdown with the Republicans, out in the open, on national television.
49:04Looking forward to listening.
49:06The president is gathering House and Senate leaders, Democrats and Republicans, to try to save health care reform.
49:11It's a high-stakes gamble that could be all or nothing for the president.
49:17The summit was an opportunity to hit the restart button on how people viewed the process.
49:24To do it all on live TV, open for the American people to see, make them feel more comfortable with the process.
49:30Here's the bottom line. We all know this is urgent.
49:33Suddenly, the president was in the driver's seat.
49:36This became a very ideological battle.
49:38They needed to show that Obama was back in charge.
49:43Political theater. One by one, he took on Republicans.
49:48The Congressional Budget Office report says that premiums will rise...
49:53Oh, no, no, no. This is an example of where we've got to get our facts straight.
49:57Let me respond to what you just said, Lamar, because it's not factually accurate.
50:01That was, I think, the moment that he stepped up in a way that he hadn't before.
50:05Let me just make this point, John, because we're not campaigning anymore. The election's over.
50:12I'm reminded of that every day.
50:16There's no question that there was a change in his style.
50:21He took ownership of this health care issue. He challenged everybody on this front.
50:27Of how we actually get a bill done.
50:30And then, for a month, Barack Obama, the campaigner, hit the road to sell the bill.
50:40Do not quit. Do not give up. We keep on going. We are going to get this done. We are going to make history.
50:51We are going to fix health care in America with your help. God bless you. And God bless the United States of America.
50:59On Sunday, March 21st, the President waited to see whether he had convinced just enough members of his own party to push the bill through.
51:11First down to the wire on health care reform. The House votes just hours from now.
51:15After months of rancor in the streets, the vote takes place in just a few hours.
51:19As ordered, members will record their votes by electronic device.
51:24Sitting in the Roosevelt Room, the President, the Vice President, we said there was a small bit of anxiety as we watched the votes tick up.
51:34It is a 15-minute vote.
51:37We've had victory snatched from us before.
51:40On this vote, the A's are 219, the Nays are 212. The motion is adopted.
51:45The 216th vote comes over. A big cheer erupts.
51:51219 to 212, no votes for Republicans.
51:55All Democrats, no Republicans.
51:57This is a huge victory for this President.
52:00For decades, they've been trying to do it. It has now been done.
52:04Good evening, everybody.
52:07This legislation will not fix everything that ails our health care system, but it moves us decisively in the right direction.
52:15This is what change looks like.
52:20It was victory, but experienced Washington knew the President would pay for it.
52:27It came at a high price. The entire first year basically dedicated to this.
52:34Having their hopes for bipartisanship dashed, and the White House still is not certain how this will sell in the country.
52:42There is a realism that it has come with a cost.
52:47We don't know what's going to happen in the November elections.
52:51We don't know what's going to happen in 2012.
52:53But there is no question that this health care battle has put his party at risk.
52:58And how they deal with that is the next chapter.
53:01But this was a historic moment.
53:05There's more to explore on our website.
53:08Health care reform will not wait another year.
53:10Watch the program again online.
53:11I had people come to my town meeting with sheaths of paper that thick off the internet and quoting from the bill.
53:19Read the extended interviews.
53:20We ended up having a process that represented a lot of what the American people hated about Washington.
53:25He says, I understand that Nancy. What's your suggestion? And there is no suggestion.
53:31Get more details on the lobbying.
53:32It's a great bill from the insurance company's point of view.
53:34Deal-making.
53:35It's not a pretty process. There is deal-making.
53:36That's the way it's been done for a long, long time.
53:37And key turning points in the long road to health care reform.
53:38Then join the discussion at PBS.org.
53:39You can see a lot of what the American people hated about Washington.
53:40He says, I understand that Nancy. What's your suggestion? And there is no suggestion.
53:47Get more details on the lobbying.
53:49It's a great bill from the insurance company's point of view.
53:51Deal-making.
53:52It's not a pretty process. There is deal-making.
53:54That's the way it's been done for a long, long time.
53:56And key turning points in the long road to health care reform.
53:59Then join the discussion at PBS.org.
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