WASHINGTON — For President Barack Obama, success came ugly, months late and without bipartisanship, but it's still a big win of historic proportion.
Obama can take credit for greatly expanding health insurance for the American people and restructuring how it works, on a scale that no president before has been able to achieve.
Historians and political experts said that Sunday's passage of the Democrats' health care overhaul by the House of Representatives, together with the Senate's expected passage of its final terms in coming days, rescues Obama from being branded a political loser in only the second year of his presidency, and probably helps limit the Democrats' expected losses in November's congressional elections.
Only time will tell whether the legislation lives up to the historic accomplishments that Democrats advertised: whether 95 percent of Americans really do get good coverage, whether people really will be able to keep their preferred doctors, whether private insurers really will be better regulated and whether the federal budget deficit really does shrink.
The tortured legislative path to victory magnified Obama's missteps and his trouble living up to his own maxims about ending closed-door deal-making with special interests. It also lacks the "public option" — a government-run health insurance alternative, which he preferred — hurt his public job-approval rating and may have cost him much of his political capital with Congress.
However, voters respect a president who gets things done more than one who doesn't. Democratic lawmakers may be more willing to back his future legislative agenda than they would be if he'd lost. With so few Republicans willing to work across the aisle, he also didn't have much to lose on that front.
"He will seem effective, or, to put it the other way around, he won't be seen as ineffective," said presidential historian William E. Leuchtenburg, a professor emeritus at the University of North Carolina at Chapel Hill and an expert on President Franklin D. Roosevelt.
"It's not going to loom as large as the Social Security Act, but he will go down in history as the man who for the first time brought health insurance to this country, something FDR did not even dare to try, that Truman tried and failed at, that Johnson stopped short on by being content with Medicare and Medicaid, but not trying to go the whole way, and that Clinton notoriously failed at. So for him to succeed will be seen as an important achievement."
Thomas E. Mann, an expert on Congress and governance at the Brookings Institution, a center-left research center in Washington, said that passage of the health care legislation would show that Democrats could get things done, regardless of Americans' concerns about the details, and that could weaken Republicans' standing. Voters will quickly forget about the controversial procedural mechanisms that Democrats used to pass the overhaul, if they were paying attention in the first place, Mann predicted.
"The narrative immediately changes. It's not dysfunctional government; it's rather that government is working," Mann said.
That could embolden Democrats to press ahead on the remainder of this year's agenda, including legislation to tighten regulation of Wall Street and big banks and a comprehensive immigration overhaul.
Sen. Lindsey Graham, R-S.C., however, said the immigration bill would be "the first casualty" if Obama and Democrats push the health care overhaul through. Graham said it would "in my view, pretty much kill any chance of immigration reform passing the Senate this year."
Democratic and Republican politicians and strategists disagree as to the political consequences of how the health care victory was eked out, from the yearlong-plus length of the debate to its inconsistent theme — was it most about reducing costs, the moral imperative of insuring everyone or the need to regulate private insurers? — to the parliamentary tactics resorted to in the end.
Tom Davis, a former Republican congressman from Virginia who's one of his party's shrewder strategists, said the victory made it easier for Democrats who voted against it to campaign without facing as much anger from their Democratic base.
However, he said that Obama would have used up his political capital getting it passed, with no more room to go to Republicans or most swing Democrats for help.
"Republicans aren't going to feel intimidated by this. And marginal Democrats are not going to want to take another tough vote. His members will say, "We gave you this vote, but no more.' They'll have given him their last ounce of breath."
Democratic National Committee Chairman Tim Kaine said "immediate deliverables" should convince Americans that the overhaul was the right thing. Children with pre-existing conditions now can't have their coverage dumped. Seniors will get a break on prescription drug costs. Parents will be able to keep their children on their policies up to age 26. Other expansions and protections would be phased in.
"They'll wonder, 'Well gosh, is there a 'death panel'? Have we seen that?'" Kaine said. "No, it didn't exist. It never existed." The months between now and the November elections will "expose that an awful lot of what the other side said was a phantom that never existed, and I think again that's going to work to our benefit."
One centrist Democratic campaign strategist who advised the Bill Clinton White House said that "the real issue is less about the process this week than the fact that it took so many months to do this." The strategist spoke only on the condition of anonymity because he didn't want his opinion to be associated with his clients who are running for re-election.
"The length of time it took, it really blocked efforts of the administration and the Congress to show the American public they were focused on job one: trying get people back to work in this country."
The president acknowledged possible political costs during his closing arguments for the health care overhaul in a speech Friday at George Mason University in Fairfax, Va.
"What does this mean in November? What does it mean to the poll numbers? Is this more of an advantage for Democrats or Republicans? What's it going to mean for Obama? Will his presidency be crippled or will he be the comeback kid?" the president mockingly channeled news coverage.
"I don't know how this plays politically," he said. "Nobody really does. I mean, there's been so much misinformation and so much confusion, and the climate at times during the course of this year has been so toxic and people are so anxious because the economy has been going through such a tough time.
"I don't know what's going to happen with the politics on this thing. I do know that this bill, this legislation, is going to be enormously important for America's future."
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