America's Bitter Pill
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2 a large group gathered with the president in the Roosevelt Room to review a PowerPoint about healthcare reform: I read notes of the meeting taken by an attendee and interviewed DeParle, Zeke Emanuel, Schiliro, and Kocher about it.
3 Obama had now signed on to the mandate, though he would not go public about it until he was pressured by Baucus (Obama pressured to write letter to Baucus, which was drafted while in flight to Egypt): DeParle, Fowler.
4 It was about an arcane health insurance term called the medical loss ratio, or MLR (Lambrew MLR memo and debate over the issue): I reviewed the MLR memo and the journal entries of a member of the staff who attended the meetings at which it was discussed, then interviewed three White House staff members who were involved in the issue.
5 UnitedHealthcare’s CEO had famously taken home more than a billion dollars in a severance package (UnitedHealthcare CEO settlement with SEC): SEC press release, December 6, 2007, http://www.sec.gov/news/press/2007/2007-255.htm.
6 President Obama had his first meeting with health industry executives: Tauzin, DeParle, Beier, and one of those executives.
7 They were surprised still more the next day when they were called back to the White House: Tauzin, three of those executives, multiple subsequent newspaper articles (including the New York Times story cited in the text), and a member of the White House communications staff.
8 This fiasco had been orchestrated by the economic team: One of the members of that team and a member of the White House communications staff.
9 DeParle upped the ante from $80 billion to $120 billion: Tauzin, DeParle, Clapsis, and internal emails among drug industry lobbyists that I reviewed.
10 Both DeParle’s shop and the economic team were nervous about those pledges: DeParle, Kocher, and Zeke Emanuel.
11 Three weeks later, on July 7, 2009, the drug company CEOs met in the White House with Rahm Emanuel, DeParle, and Baucus and shook hands on the deal: DeParle and Tauzin, as confirmed by documents subpoenaed by the House Energy and Commerce Committee that I reviewed and that committee’s subsequent report: http://archives.republicans.energycommerce.house.gov/Media/file/PDFs/20120531ObamacareDeals.pdf.
12 Harry Reid immediately turned his attention to making sure that he could keep every Democrat on board. Baucus, however, still wanted a bipartisan deal: Although, again, McDonough’s Inside National Health Reform provided much of the foundation for this reporting about the legislative wrangling, my sources included DeParle, Senators Snowe and Grassley, two Democratic senators who asked not to be named, Fowler and Clapsis, eleven Senate and six House staff members who asked not to be named, and a daily journal kept by a White House staff member.
13 Dodd was constantly on the phone consulting Kennedy, who was confined to his Cape Cod home: Vicki Kennedy.
14 Fowler assured her that the Finance Committee bill would try to fix the age band: Zirkelbach and Fowler.
15 Amgen deployed the kind of muscle on Capitol Hill that had become standard: Data on Amgen’s lobbying and campaign spending was compiled for me in a special data search conducted by the Center for Responsive Politics (http://www.opensecrets.org).
16 But Amgen had more than that. The company had David Beier: Tauzin, Kocher, Beier, and two Senate and three House staff members who asked not to be named.
17 With Ted Kennedy happily watching the proceedings on C-SPAN: Vicki Kennedy.
18 the president met with Reid, Baucus, and House Speaker Nancy Pelosi to resolve who should get subsidies: This meeting and what was discussed were recorded in the notes of a White House staff person working on healthcare.
19 Reid and his staff had especially little use for Baucus’s romancing: Senator Snowe, Clapsis, and Fowler.
20 Snowe, with whom Reid had a frosty, often dismissive relationship: Three senate staff members and Senator Snowe.
21 Snowe was thought by some around the Senate to be difficult to work with: Two senators and five Senate staff members.
22 Grassley, too, persuaded Baucus to make dozens of changes: Fowler, Clapsis, Schwartz, Senator Grassley, and two members of Grassley’s staff.
23 Baucus’s efforts to accommodate Grassley and Snowe seemed to be working. Even DeParle thought so (DeParle meetings with Grassley and Snow): DeParle and Senators Grassley and Snowe.
24 White House “Innovation” meeting and meetings with Justice and FTC officials: Zeke Emanuel, Kocher, and detailed journal entries of a White House staff member.
25 Orszag and Larry Summers and their staffs had been lobbying the House and Senate staffs to include something that they argued would be a real cost cutter: Summers, Orszag, Zeke Emanuel, and detailed journal entries of a White House staff member.
26 approval ratings for reform were quickly dropping into negative territory, and Simas report on poll numbers and subsequent meeting where he described the “two evils”: Journal entries, including a sketch of Simas’s whiteboard diagram, by a White House staff member who attended the Simas meetings, confirmed by two White House staff members.
27 Two economics aides—Summers deputy Jason Furman and Treasury’s Gene Sperling—began working on a slimmed-down, fallback reform plan: Staff member’s journal entry, confirmed by that staff member.
28 “Why can’t I explain that this is about costs and not just coverage?” Obama complained: This, too, comes from notes entered into the staff member’s journal.
29 “Government takeover” would become the prime phrase he featured in a “words that work” memo he distributed to Republicans: Luntz. I also reviewed his memo.
30 Ignagni was upset although not surprised: Ignagni and Zirkelbach.
31 soda industry and retailers had convinced Baucus to take the soft drink tax off the table: Staffer’s journal entry and Fowler.
32 It seemed like every day some senator or another added something new to Baucus’s working draft or took something out: In addition to journal entries from a White House staffer: DeParle, Senators Snowe and Grassley, two Democratic senators who asked not to be named, Fowler and Clapsis, and eleven Senate and six House staff members who asked not to be named.
33 Orszag and his team infuriated Lambrew by contradicting her numbers: Staff member’s journal entry and interview with that staff member.
34 Deliberations about grandfathering: This was the subject of extensive, detailed entries in the staff member’s journal.
CHAPTER 10: THE TEA PARTY SUMMER, “I’M FEELING LUCKY,” AND “YOU LIE”
1 During August conference calls, the drug company executives and Karen Ignagni’s insurance industry bosses signaled that they had gotten the message, too: Ignagni, Zirkelbach, and a pharmaceutical company chief executive who was involved in the PhRMA deliberations.
2 “Of course, I’m feeling lucky,” Obama answered: Details of this meeting have been reported elsewhere, including an account by Valerie Jarrett in a New York Times Magazine “oral history” compiled by Peter Baker and published on January 16, 2013; I confirmed the exact date and conversation with Schiliro.
3 Valerie Jarrett went into high gear, too; advises Obama they can survive Tea Party Summer: Schiliro and a member of the White House communications team.
4 Zeke Emanuel was confident enough that he began looking ahead to when the law would be on the books (conversation with Rahm Emanuel): Zeke Emanuel and Rahm Emanuel.
5 One of the Catholic bishops in attendance bent his ear about abortion: This comes from Landmark: The Inside Story of America’s New Health-Care Law, a book by the reporting staff of The Washington Post (New York: Public Affairs, 2010). This anecdote can be found on page 28.
6 they would leave the doc fix out of the bill: Zeke Emanuel, DeParle, and Kocher; it was also recorded in journal of White House staff person.
7 the Congressional Budget Office scoring process: Multiple articles about the CBO; a review of congressional testimony of CBO officials; and Orszag, Gruber, Fowler, and four congressional staff
people who asked not to be identified.
8 Some healthcare experts estimated that malpractice reform could save as much as $70 billion a year (5 percent of hospital and doctor expense): This was a consensus I gathered during my reporting for the Time special issue. However, because I have seen so many varying estimates, I reduced my calculation in the text to 1 percent.
9 the best they could do was ask the president to talk to Reid and try to persuade him at least to include some kind of test programs (White House discussion regarding malpractice reform): Zeke Emanuel and the journal entries of a White House staff person.
10 When Ted Kennedy was told in May that he had little time left, he wrote a letter to Obama: Vicki Kennedy.
11 Schiliro and his congressional liaison team thought the speech had worked: Schiliro and one member of the White House communications staff.
CHAPTER 11: SNOW JOBS, POISON PILLS, AND BOTOX
1 The Obama staff knew Baucus’s draft was coming but did not know all the details: Zeke Emanuel, Kocher, DeParle, and Fowler.
2 More than that, as senior political adviser David Axelrod had constantly reminded the group, Obama had spent tens of millions of dollars in campaign ads attacking John McCain for wanting to remove the tax exclusion on workers’ healthcare benefits: Zeke Emanuel and the journal of a White House staff member. Emanuel also describes this debate in a book he wrote about Obamacare: Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System (New York: Public Affairs, 2014).
3 Predictably, the economic team had a different view: Kocher, Zeke Emanuel, Summers, Orszag, and DeParle.
4 staff and senior Treasury Department officials began in September to go over a new list of taxes or penalties: Journal entries kept by a person who was involved in these discussions; Orszag.
5 the Senate Finance Committee started its debate on Baucus’s draft: Clapsis, Fowler, Schwartz, Senator Grassley, Senator Snowe, and three other Finance Committee staff members. There were also several vivid descriptions of these sessions in newspaper coverage at the time, particularly an article by David Herszenhorn of The New York Times, published on October 13, 2009: http://prescriptions.blogs.nytimes.com/2009/10/13/behind-the-14-9-vote-a-247-committee-staff/.
6 The senators grilled Fowler and the staff over thousands of details, and proposed 564 amendments, of which 135 were voted on: This tally is from McDonough, Inside National Health Reform.
7 “You mean the Snowe-Schumer amendment, right, Chuck?”: Senator Snowe.
8 The vote on a more lenient mandate panicked Gruber: Gruber, Fowler, and Cutler.
9 Schumer’s strategy was simple: Three Finance Committee staff members.
10 House members’ concern about, and fight over, abortion: Most of my knowledge of the basics here comes from news clips; McDonough, Inside National Health Reform; and the Washington Post staff, Landmark, though I supplemented it with interviews with DeParle, Fowler, three Republican House staffers, and two Democratic House staffers. Also, a journal kept by a White House adviser tracked these developments closely.
11 White House meeting of the healthcare reform team during the second week in November: From notes taken by one attendee and the journal entries of another.
12 Joe Lieberman, the Democrat from insurance-industry-friendly Connecticut, told Reid: Three Senate staff members.
13 She was shunned when she showed up at lunches of the Senate Republican caucus: Fowler, Clapsis, and two other Senate staff members.
14 Evan Bayh of Indiana still thought the tax on his medical device companies back in Indiana was too high: Clapsis, another Senate staff member, and a lobbyist for the device industry. I also saw the industry’s lobbying white paper.
15 Blanche Lincoln of Arkansas wanted a change that would ease the penalty on employers: This, along with the “Cornhusker Kickback,” the “Louisiana Purchase,” and the bargain with Lieberman, was widely reported, but I got the core of my information on all of them from interviews with Clapsis, Fowler, and three other Senate staff members, as well as from McDonough, Inside National Health Reform, and The Washington Post staff, Landmark.
16 “This is essentially the collapse of health reform”: Bob Kinzel, “Dean on Health Care: ‘Kill the Senate Bill,’ ” December 15, 2009, http://www.vpr.net/news_detail/86681/dean-on-health-care-kill-senate-bill/.
17 Republicans hatched a plan to launch a poison pill: Two staff members for Republican senators, McDonough, Clapsis, Fowler, and McDonough, Inside National Health Reform.
18 Jay Rockefeller told the Huffington Post, “I don’t think that’s going to get my vote”: Ryan Grim, “Pharma Deal Shuts Down Senate Health Care Debate,” March 18, 2010, http://www.huffingtonpost.com/2009/12/11/pharma-deal-shuts-down-se_n_388895.html.
19 Snowe sat down and quickly told the president she couldn’t vote yes—yet: Senator Snowe and DeParle.
CHAPTER 12: NEW TROUBLE, THEN MOUNT EVEREST
1 Kocher had been talking to another potential leader working in the Obama administration: Kocher and Park.
2 Kocher also talked with the U.S. chief technology officer at the White House, Aneesh Chopra: Kocher and Chopra.
3 Nancy-Ann DeParle wrote her own implementation memo: I did not see this memo; I was told about it by DeParle, Zeke Emanuel, and Bob Kocher.
4 they pushed Summers and Orszag to talk to Rahm Emanuel: Zeke Emanuel, Rahm Emanuel, Kocher, and Orszag.
5 Negotiations between Senate and House Democrats: Clapsis, Fowler, DeParle, Kocher, Zeke Emanuel, and Beier. Also, contemporaneous news accounts from The Washington Post and The New York Times, as well as McDonough, Inside National Health Reform.
6 The Democratic negotiators spent the entirety of January 12, 2010, getting through thirty-five pages of what was going to be a more than nine-hundred-page bill. Zeke Emanuel was kicked out of the room for arguing too much: This is from notes entered into a journal by one of the participants; I confirmed it with two participants.
7 The policy team was sure Zeke Emanuel had instigated the article, which he indignantly denied: Kocher, Zeke Emanuel.
8 The groups were working on the Sunday before Election Day: Clapsis, Fowler, Schwartz, and Baucus staff aide Sean Neary.
9 One group adjourned to a bar: Clapsis, Fowler, Schwartz, and Neary.
10 Karen Ignagni called one of her contacts at the White House: Notes taken during the call by a member of the White House staff, then confirmed by Zirkelbach (of AHIP) and DeParle.
11 DeParle’s staff was preparing a memo for the president suggesting exactly that fallback: Journal entry by a staff member, then confirmed by DeParle and another staff member.
12 Fowler went online to see how much it would take to open a franchise for Potbelly: Fowler.
13 “Leader Reid’s office said we are done with health care for the year”: White House staff member’s journal entry, confirmed with three Senate staff members.
14 The conservative Scalia kidded Emanuel: Zeke Emanuel.
15 At Rahm Emanuel’s behest, his brother and others on the Obama team had begun playing with a drastically scaled-back proposal: Rahm Emanuel, Zeke Emanuel, and a White House staff member’s journal entry.
16 Obama had told the staff that he had not given up yet: Schiliro and Rahm Emanuel.
17 Development of new strategy to turn them into one bill that could become law despite the apparent loss of the sixtieth Senate vote: Schiliro, Zeke Emanuel, and DeParle.
18 “I got you elected and now you won’t do this? Thanks for nothing”: DeParle.
19 Karen Ignagni at America’s Health Insurance Plans had a similar reaction: Zirkelbach and Ignagni.
20 “the Mount Everest” of American domestic policy challenges: Over the course of my research I believe I read a book in which the author used this metaphor. Howe
ver, when I checked my notes I couldn’t find which book or author. I then solicited an email list of healthcare policy experts to ask who might have coined this phrase and got several answers indicating variations on the metaphor had been commonly used, including, for example, that writer Robert Kuttner had used it in a 2008 television interview in discussing Obama’s Challenge, a book he had written about the coming Obama presidency. I don’t think that’s where I first heard it. All that I am sure of is that I did not think of it on my own. I apologize for not being able to credit who put this phrase into my head.
21 collecting autographs from the legislators: Zeke Emanuel.
22 Fowler didn’t collect autographs, but she was given a signing pen by Obama: Fowler.
CHAPTER 13: IN WASHINGTON “EVERYTHING IS SLIPPING,” BUT NOT IN KENTUCKY
1 Discussions and debate at White House implementation meetings: Unless otherwise indicated, in all cases my initial source for discussions and debate at White House implementation meetings was a detailed journal kept by one of the participants. I then confirmed what that person recorded with at least two other participants. In no case did any participant contradict anything recorded in this journal that is reported in the text.
2 “STOP!” was the only reply he got: Recounted in a staffer’s journal and confirmed by Chopra.
3 DeParle and Lambrew were giving biweekly memos to the president: Zeke Emanuel, Kocher, a member of White House communications team, Orszag, and Fowler.
4 9,625 pages of regulations covering Obamacare: There have been varying page counts reported in the press and alleged by critics of the law, but the most careful count seems to be Glenn Kessler’s in his Washington Post fact-checking blog. In a May 15, 2013, post he counted 9,625 pages of rules and another 7,432 pages of proposed rules. There have probably been hundreds, if not thousands, of more pages promulgated since then.
5 he had heard a Republican staffer say something about the Commerce Clause: Clapsis.