Mayor 1%. Kari Lydersen
health-care costs, which would theoretically make health-care more accessible to a wide range of people (though it would likely cut into profits for hospitals, drug companies, and doctors).
Obama promoted the idea of cutting costs in part through evidence-based medicine—making decisions based on studies showing which procedures and drugs really yielded the best results, and ferreting out instances where surgeries or other expensive treatments were widely used despite showing little or no better outcomes than less expensive and less invasive options. Among the leading advocates of this approach was Zeke Emanuel, Rahm’s brother, who was advising the White House on health care.35 But as described in various books and articles based on inside sources, Rahm Emanuel pushed back against comprehensive health-care reform, trying to dissuade Obama from tackling health care during the economic crisis and then advocating strenuously against a public option and in favor of a much narrower version of reform.
Emanuel was a key liaison to pharmaceutical companies, hospitals, and Republican leaders during the debate. He reportedly promised pharmaceutical companies that the law would not include price controls on drugs and would not allow cheaper drug imports from Canada and Europe—measures that could have been beneficial for low-income people struggling to afford medication.
As Jodi Kantor explained in her book The Obamas:
Rahm Emanuel and Jim Messina, a deputy chief of staff, had cut a quiet deal with pharmaceutical industry lobbyists: in exchange for supporting the legislation, the administration would guarantee that it would cost the companies no more than $80 billion. Many White House aides were surprised and alarmed: Obama had campaigned as a reformer who would fight lobbyists and pharmaceutical companies, and now he was cutting a backroom deal with them that looked like a giveaway?36
Emanuel tried to push Obama to agree to a smaller health-care program that would add only about ten million Americans to the insurance rolls. It was dubbed “the Titanic Strategy” because it would primarily expand coverage for single women and children.37
According to Ron Suskind, Emanuel tried to shield Obama from outside advice on health-care reform, including from his friend and health-care expert Tom Daschle. Suskind quoted a longtime Washington manager saying Emanuel “convinced Obama that ‘all Rahm, all the time’ was all he needed. . . . Obama didn’t know how things were supposed to work, and Emanuel, running in every direction, wasn’t going to tell him.”38
Meanwhile, some critics argued that despite Obama’s early statements in favor of a public option, the much less comprehensive bill that eventually passed was what he “wanted in the first place,” in the words of Wisconsin Democratic senator Russ Feingold.39
“Contrary to Obama’s occasional public statements in support of a public option, the White House clearly intended from the start that the final health care reform bill would contain no such provision and was actively and privately participating in efforts to shape a final bill without it,” wrote pundit Glenn Greenwald in Salon. “Engineering these sorts of ‘centrist,’ industry-serving compromises has been the modus operandi of both Obama and, especially, Emanuel.”40
One of the issues that stalled and nearly killed health-care reform was the debate over the use of government funds for abortion. On this point, Emanuel brokered a crucial compromise. Obama agreed to sign an executive order saying federal funding would not go to abortion in order to get congressmen to drop an amendment proposed by Michigan Democratic congressman Bart Stupak that would have included such a prohibition in the actual bill. While many abortion rights advocates decried the compromise, mainstream prochoice organizations supported it as the lesser of two evils.The right-wing blogosphere crowed that Emanuel was “pro-abortion” and that the executive order had loopholes that would allow federal funding in some situations. Emanuel later explained that the compromise was necessary to get the fourteen congressional holdout votes that were crucial for the bill to pass.41
The health-care bill hammered out during a torturous year-plus process was eventually signed by Obama on March 23, 2010. It offered significant gains for regular Americans: insurance companies could no longer bar people with pre-existing conditions, young adults could remain on their parents’ insurance until age twenty-six, and about thirty-two million more Americans would be covered.42 As noted on the White House website, 105 million Americans were relieved of lifetime dollar limits on their coverage, and insurance companies could no longer drop people when they got sick or made a mistake in paperwork.43
Watered down as it was, the bill qualified as a historic achievement, and Emanuel surely deserves some credit for making it happen. It’s impossible to know if a wider-ranging bill could have passed with more political will and a different strategy. But for people left angry and disillusioned that the reform didn’t go further, perhaps the question shouldn’t be so much about Emanuel’s approach but rather about the larger system supported by corporate influence and poisonous rhetoric—a system that meant the chief of staff could have been correct in betting this was the best the government could do.
Immigration
Immigrants’ rights groups and immigrant community leaders turned out in force to campaign for Barack Obama, including by helping people become citizens and registering new voters likely to cast their ballots for him. The alliance made sense given Obama’s family history and home base in Chicago, with its rich immigrant communities, pro-immigrant politicians, and powerful immigrant organizations. Immigrants’ rights advocates pushed Obama to promise he would tackle immigration reform within his first hundred days in office. The candidate responded in an interview with ABC that he would make immigration a priority and address it within his first year. But a year came and went, with no reform bill in sight.44 The Obama administration ultimately ended up deporting immigrants at a faster clip than President Bush had.45 Many law-abiding, hard-working immigrants were ensnared in the controversial Secure Communities program, which was supposed to remove serious criminals but instead targeted many people with traffic or minor drug offenses.46
As with climate change and the public option, the buzz on immigration was that Emanuel had dissuaded Obama from tackling it. During his time in Congress—when he reportedly advised Democrats in close races to vote for the stridently anti-immigrant Sensenbrenner bill—Emanuel had labeled immigration the “third rail of American politics.”47
Comprehensive immigration reform during Obama’s first year—or at any time—was a tall order, to be sure. But during Obama’s first two years there was no significant progress on smaller and more urgent pieces of the immigration puzzle, like the DREAM Act, which would offer legal residency to undocumented students who came to the country as children, or legislation to prevent undocumented parents from being deported and separated from their citizen children. (In June 2012, in the midst of his reelection campaign, Obama issued a directive blocking the deportation of youth who would have been covered by the DREAM Act.)48
During Emanuel’s mayoral campaign, his opponents would hammer him for his stance on immigration during his time in Congress and the White House. Emanuel responded that he did not “kill” the DREAM Act, as some had phrased it, and declined to discuss his private interactions with President Obama.49
The Los Angeles Times quoted Arizona Democratic congressman Raúl Grijalva saying, “There’s always a sense that no matter how hard we work, to get through the White House, we have to get through Rahm. . . . I would like immigration not to be part of the chief of staff’s portfolio. It would make our ability to convince and access decision-makers in the White House a lot easier.”50
That story also quoted New Democrat Network president Simon Rosenberg saying, “It’s going to be much easier for this issue to move after Rahm Emanuel leaves the White House. . . . Rahm has a long history of a lack of sympathy for the importance of the immigration issue.”51 Indeed, in June 2013, a wide-ranging immigration reform bill—including a path to citizenship for undocumented immigrants—passed the Senate, though its fate in the House remained uncertain.52
Liberals Attack Emanuel
In August 2009, during a confidential White House strategy session, Emanuel met with liberal activists upset with the administration’s failure to push aggressive health-care reform. The activists were planning to run ads attacking