Six years ago, presidential candidate Barack Obama stood before Iowa voters and introduced a plan designed to extend healthcare to all Americans.
"We can do this," he said with confidence. "The time has come for universal, affordable healthcare in America."
Three years ago, President Obama signed into law a plan designed to extend coverage to more than 30 million uninsured people.
Editor's Note: ObamaCare Secrets Revealed
"This is what change looks like," he exulted.
But it has become clear that Obama's vision for universal health care is dramatically different than it was that day in Iowa. The president has been forced to cut, reshape and compromise on his signature Patient Protection and Affordable Care Act because of economic — and political — realities.
Obamacare, the president’s singular major domestic achievement, was immediately attacked by Republicans, conservatives, physicians, business groups — even members of his own Democratic Party — as too expensive, too cumbersome — and just plain unworkable.
“I just see a huge train wreck coming down," Senate Finance Committee Chairman Max Baucus, a Montana Democrat, said at an April budget meeting.
GOP legislators have consistently called for Obamacare’s repeal.
Then, this week, the Obama administration delayed the requirement that medium and large companies provide coverage for their workers or face heavy fines. And what started out as a promise of universal health care for all has now become something far different.
Here is how Obamacare’s scope has narrowed in recent years:
Public option? Never mind.
President Obama once trumpeted the idea of providing a public option in health care, essentially a government-run plan that would be one of many choices for people seeking affordable care.
That idea, long opposed by conservatives and many moderates, never made it into Obamacare. In the quest for a workable compromise, the White House deemed it expendable.
Long-term care insurance? No such thing.
When Obama signed his healthcare plan into law, it included a proposal to provide basic long-term care insurance at an affordable cost. But before the program ever got off the ground, the administration ditched it last spring for fear it would turn into a financial drain. It could take years before lawmakers tackle the issue again.
Coverage for the neediest? Not in every state.
Obamacare envisioned millions of the neediest Americans gaining health insurance by enrolling in Medicaid, with coverage starting in January. But the Supreme Court threw a wrench in that plan last year when it gave states the right to opt out of the Medicaid expansion plan.
Because of Republican opposition in many states, it looks like nearly two in three of those who would qualify for new Medicaid coverage may be out of luck because their state lawmakers have not agreed to expand the program.
What about workers? A longer wait.
Obamacare requires companies with 50 or more workers to offer affordable coverage to full-time employees or risk escalating tax penalties. Originally, that requirement was supposed to take effect on Jan. 1. But now the administration is pushing that requirement back a year, citing the complexity of the undertaking.
Most medium and large businesses already offer health insurance. Those most likely to be affected by the delay: low-wage workers at hotels, restaurants and stores.
In addition, because the individual mandate remains in place, workers may now be forced to buy their own insurance or pay a penalty because their employers don’t provide coverage, according to the Cato Institute, a Washington-based public policy think tank.
The administration’s decision essentially shifts the cost from employers to workers. This hardly seems fair, the Cato Institute contends, and may force the White House to even rethink the individual mandate.
Meanwhile, what’s left?
Starting next year, individuals will be required to carry health insurance or face fines.
People who are uninsured can to shop for affordable coverage through the online marketplaces that are scheduled to be in place on Oct. 1.
Prominent Democrat, Sen. Jay Rockefeller of West Virginia, who also helped create Obamacare, said that the law was “so complicated — and if it isn’t done right the first time, it will just simply get worse.”
Those fears came to light this week, when the White House delayed the employer mandate until 2015 — leading many GOP legislators to echo predictions and cite yet another reason for doing away with Obamacare.
"The president's healthcare law is already raising costs and costing jobs," House Speaker John Boehner said this week. "This announcement means even the Obama administration knows the 'train wreck' will only get worse.
"I hope the administration recognizes the need to release American families from the mandates of this law as well," the Ohio Republican said. "This is a clear acknowledgment that the law is unworkable, and it underscores the need to repeal the law and replace it with effective, patient-centered reforms."
In May, the GOP-controlled House voted — for the 37th time — to repeal Obamacare.
“This thing is so bad, that there’s no salvation for it,” Rep. Michael Burgess, a Republican who is an obstetrician in his Texas district, told Newsmax this week. “You’re seeing more evidence, every day, that the train wreck that Max Baucus foretold is going to occur.”
And throughout next year’s congressional election season, Republicans will work feverishly to tie Democratic hopefuls to Obamacare, GOP strategists say.
“It’s the gift that just keeps on giving,” Brad Todd, a Republican media consultant, told Politico. “For Republican political strategists, having Obamacare is like being in the Beer of the Month Club. Every month, you get a new care package in the mail.”
Oregon Rep. Greg Walden, chairman of the National Republican Congressional Committee, said the White House was delaying the mandate to save Democrats at the polls next year.
Editor's Note: ObamaCare Secrets Revealed
“They are realizing today what’s going to happen next year, and they’re trying to scramble and dodge,” Walden told Politico. “This isn’t going away. It’s only going to get bigger and deeper.”
The Associated Press contributed to this report.
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