Barack Obama has reached his historic moment.
After more than a year of heated debate, backroom maneuvers, and pitched partisan wrangling, President Obama stands on the verge of enacting comprehensive reform of the American healthcare system.
The House Democrats' passage of reform legislation Sunday night means Mr. Obama will have succeeded where presidents going back decades before him have failed, setting the stage for the biggest expansion of the American social safety net in nearly 50 years.
A soured public, a narrowed agenda
But the cost to Obama has been profound. He began his presidency 14 months ago with sky-high approval ratings of 70 percent and a big, ambitious agenda that began with a record economic stimulus package, then turned quickly to healthcare. Climate change and financial regulatory reform stood next in line. Obama's original goal was to complete healthcare last summer, but the road got so bogged down in a fruitless effort at bipartisanship – and a fierce conservative backlash – he was forced to go it alone with only Democratic votes.
Obama's job approval now hovers just below 50 percent. And while his hard-fought victory on health reform will give the president and his Democratic allies a boost of confidence going forward, they have burned up so much political capital that analysts see little room for more major initiatives anytime soon.
"If the administration is wise, it will understand that with the possible exception of financial regulatory reform, they've shot their wad for this Congress," says William Galston, a former policy adviser to President Bill Clinton and a senior fellow at the Brookings Institution.
With the Democrats expected to take big losses in the November midterms, possibly even losing control of the House, Obama may well be forced to rethink his approach come January.
More to do on healthcare
The health reform issue itself is far from over. Public opinion polls generally show disapproval and confusion toward the package, and both sides in the debate plan public relations offensives to further shape its image. The White House has been quietly planning a PR blitz by the president to build support for the reform after its enactment. Obama will also mark milestones, such as the day children can no longer be excluded from healthcare coverage because of preexisting conditions, according to a senior administration official. That will come six months after the bill's signing.
Outside groups will also get into the act in a big way, explaining to the public what the plan will do and helping to ensure that people who will now qualify for subsidies to purchase insurance or enrollment in Medicaid take up that option. About half of the 32 million uninsured the plan is projected to cover will be eligible for Medicaid or government-funded insurance.
Just as President George W. Bush's initially unpopular prescription-drug plan for seniors gained approval as it was implemented, so, too, supporters of Obama's healthcare reform are hoping that as the benefits phase in, the public will see merits. The political challenge, though, is that some benefits do not kick in for another four years – after the next presidential election.
With healthcare's passage, a boost for Democrats?
Some analysts see the passage of healthcare as helping Obama, and to a lesser degree the Democratic leadership on Capitol Hill, to rebuild political capital.
"Republicans have fought him on every turn, ... and I think he will be both personally and politically rejuvenated," says Cal Jillson, a political scientist at Southern Methodist University in Dallas. "He'll be able to move back into economic recovery and job creation."
Indeed, in the home stretch of congressional action, Obama found his old campaign voice, delivering rousing speeches at rallies around the country. Just before midnight Sunday night, right after the House vote, Obama marked the moment in the East Room of the White House.
"Tonight, at a time when the pundits said it was no longer possible, we rose above the weight of our politics," Obama said. "We pushed back on the undue influence of special interests. We didn't give in to mistrust or to cynicism or to fear. Instead, we proved that we are still a people capable of doing big things and tackling our biggest challenges."