Nancy Pelosi’s Fight: How She Revived Obamacare After Democrats Left it for Dead

Nancy Pelosi, a complicated political figure, saved the Affordable Care Act from Democratic destruction.

House Minority Leader Nancy Pelosi (D-CA) leaves after a briefing on Capitol Hill on November 15, 2018 in Washington, DC. (Photo by Brendan Smialowski / AFP)        (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
House Minority Leader Nancy Pelosi, D-Calif., leaves after a briefing on Capitol Hill on Nov. 15, 2018 in Washington, D.C. Photo: Brendan Smialowski/AFP/Getty Images

Barack Obama’s great strength was always his ability to shape himself into a vessel for the hopes of a wide array of different people. For Nancy Pelosi, it’s been the reverse, as she manages to become a symbol of the varying fears of the opposing factions of the Democratic Party.

For the party’s left, she’s too tied to big money and the corporate PAC model of fundraising, and embraces a “paygo” politics of austerity. For the party’s right, she’s a spend-happy, San Francisco liberal whose presence at the top puts the new majority at risk.

The legend of Pelosi has it that after raising her five children, this stay-at-home-mom decided to throw herself into politics and thus was born the first woman speaker of the House in U.S. history. The impressive feat of child-rearing is accurate, but the rest leaves a lot out. And onto that blank page, foes have been all too happy to write their own stories of Pelosi.

Pelosi’s confounding image is built on her unique political foundation. It’s true that she did not enter elected public office, in 1987, until she had finished raising her five children. But she was by no means new to politics.

Democratic Rep. Phil Burton, upon seeing the San Francisco mansion she shared with her husband, investor Paul Pelosi, noted that it would make a tremendous location for political fundraisers. Pelosi, it turned out, had a gift for just that, and her fundraising prowess would eventually turn her into a power center in California politics in her own right. In 1976, more than a decade before entering Congress, she was elected as a member of the Democratic National Committee. Over the next five years, she would become chair of the northern California Democratic Party and then the statewide Democratic Party. In 1985, she lost a bid for DNC chair.

Burton, who served in Congress for 19 years, was a transformative political figure both in California and in the education of Pelosi. Labor reporter Harold Meyerson once called him “the single most important member of the House of Representatives in the ’60s and ’70s.”

Pelosi is often lauded for her uncanny ability to count votes, something that was also said repeatedly of Burton. He was a role model for Pelosi, someone who was enthusiastic about fundraising and took politics seriously, rather than a purist who stood aloof from what many on the left saw as a corrupt endeavor. “I’m a fighting liberal,” Burton would famously say. His biographer, John Jacobs, agreed: “A ruthless and unabashed progressive, Burton terrified his opponents, ran over his friends, forged improbable coalitions, and from 1964 to 1983 became one of the most influential Representatives in the House. He also acquired more raw power than almost any left-liberal politician ever had.”

Fighting meant getting your hands dirty. Burton pioneered gerrymandering in California (“My contribution to modern art,” he called it; he even drew a district so that his brother John could have a House seat, too) and began what is now a common practice of spreading PAC money around to colleagues in tough races in order to build power within the caucus. He helped shape the House floor process so that lobbyists would have more ability to tweak individual pieces of legislation, uncorking contributions from K Street and helping to create the Washington ecosystem we know today. Burton encouraged Pelosi to run in one of the new districts he had drawn, but she demurred.

First elected in 1964, he took on the power of the Southern bulls, who had used seniority and one-party rule in the South to lock down control of key committee chairpersonships. The sooner the party could crush its Dixiecrat wing, he argued, the better. Burton organized his liberal colleagues and reformed the process for selecting chairs, replacing it with a secret vote, which was the beginning of the end of Southern dominance of the House Democratic caucus.

In 1976, he fell one vote short in a bid for majority leader.

In Pelosi, Burton had a ready student. If your knowledge of Pelosi comes from Republican attack ads, you know her as a “San Francisco liberal” or even “radical,” but she was raised in Maryland by her father Thomas D’Alesandro Jr., the boss of the Baltimore political machine, who was by turns a congressman and mayor of Charm City. D’Alesandro’s operation, like most big-city machines of the era, was linked in public to local Mafia figures, according to his FBI file.

Burton rightly saw in Pelosi that rarest of breeds, a liberal born to fight. In Burton, Pelosi found someone who knew how to make progressive change actually happen. His list of legislative achievements was long — Supplemental Security Income, a higher minimum wage, compensation for black lung, food stamps for striking workers, the abolition of the House Un-American Affairs Committee — despite or, in part, because of his legendary ruthlessness and rage.

John Burton, Phil’s brother and himself a former congressman, said that Phil never quite mentored Pelosi. “I mean, Christ, this is a woman who was brought up in Baltimore politics. He wasn’t working with some neophyte that all of a sudden he had to explain, ‘Well, here’s how it works.’ They got along because even though she was an ‘amateur’ at that time, she was still a pro,’” Burton told the author Vincent Bzdek for the book “Woman of the House.” He acknowledged, though, that Phil helped “hone her skills.”

Pelosi said that her Baltimore education made Burton easy to handle. “Actually, my family really prepared me for Phil Burton. One of the reasons I got along with Phil is because I wasn’t afraid of him. I knew a lot of people like him,” she told Bzdek.

In April 1983, at the age of 56, he died of a heart attack; his wife Sala Burton won the special election to replace him. But four years later, she lay dying herself and made a parting death bed endorsement: “Nancy.”

The nod helped, and Pelosi won the special election in 1987 to represent the Burtons’s San Francisco district. She ran on the prophetic and on-brand slogan “a voice that will be heard,” and brought with her the conviction that effective fundraising was the key to building power and that without power, she couldn’t enact her agenda. By 2002, she’d become the first progressive in a generation elected to leadership, serving as minority whip. When Democratic leader Dick Gephardt stepped down, she became minority leader, using the position to rally her caucus against the war in Iraq.

Pelosi, who’d become the first female speaker of the House after the Democrats took the House majority back in 2006, got the opportunity to go big and fulfill a centurylong liberal dream, after Obama’s 2008 election. But it almost all fell apart.

FILE - In this March 23, 2010, file photo, President Barack Obama signs the health care bill in the East Room of the White House in Washington. Since his campaign days, President Donald Trump has addressed health care in broad, aspirational strokes. He made some clear promises along the way. Those promises come under two big headings. First, what Trump would do about the Affordable Care Act, his predecessor's health care law, often called "Obamacare." Second, the kind of health care system that Trump envisions for Americans. (AP Photo/J. Scott Applewhite, File)

On March 23, 2010, President Barack Obama signs the health care bill in the East Room of the White House in Washington, D.C.

Photo: J. Scott Applewhite/AP

The train wreck that nearly derailed the Affordable Care Act in 2009 and 2010 was visible from miles away. Michael Capuano, a congressman from eastern Massachusetts, saw it coming.

When Massachusetts Sen. Ted Kennedy died in August 2009 of brain cancer, his passing created a vacancy that was filled by Paul Kirk, a longtime Kennedy aide appointed as a placeholder while a special election was organized. (Coincidentally, it was Kirk who had beaten Pelosi in the ’85 DNC chair race.)

On December 24, 2009, Kirk cast the 60th vote to break a filibuster and pass the Senate version of the Affordable Care Act, a slightly more corporate-friendly plan than the one that had passed the House on November 7. That bill, shepherded through by Pelosi, included a public health insurance option to compete with private plans in the marketplaces that would be created by Obamacare. It was not the more robust version of the public option that the Congressional Progressive Caucus had pushed for, but the bill was broadly considered more aggressive, and the two chambers planned to hash out their differences in a conference committee.

Two weeks earlier, Democrats had held a Senate primary contest, pitting Capuano against Attorney General Martha Coakley. Former President Bill Clinton, EMILY’s List, and other party leaders got behind Coakley. The only statewide official in the race, she easily dispatched of Capuano in the December primary. “They said that women don’t have much luck in Massachusetts politics,” she declared at her party that night. “And we believed that it was quite possible that that luck was about to change.”

Assured of victory in the coming January general election, she tried that luck and departed for a two-week vacation in the Caribbean. Yet Capuano returned to Washington shaken by what he’d seen on the campaign trail. He was invited to brief a private gathering of House Democrats in the basement of the Capitol.

He leaned into a standing microphone, looked around the room at his colleagues, and, according to one of the lawmakers present, delivered a two-word speech: “You’re screwed.”

As the gathered House Democrats gradually realized they had heard the extent of his speech, the silence was punctuated only by soft, nervous laughter. Later, Capuano elaborated on the theme: Everywhere he went in Massachusetts, he said, he met people who were absolutely livid at the anemic approach to job creation in the wake of the crisis. That rage, he warned, was going to be turned against Democrats at the polls if they didn’t deliver.

Coakley, still on the beach, saw it too late. In January 2010, Scott Brown, the butt of jokes for his nude Cosmo centerfold, delivered a stunning upset, depriving Democrats of their 60-vote supermajority.

That meant that any bill that would emerge from conference committee would need at least one Republican to support it, or Democrats would have to nuke the filibuster. Neither possibility appeared likely, and the fate of bill was suddenly in doubt.

Democrats, including Pelosi ally Rep. Barney Frank of Massachusetts, began writing its obituary. Offered Frank:

I feel strongly that the Democratic majority in congress must respect the process and make no effort to bypass the electoral results. If Martha Coakley had won, I believe we could have worked out a reasonable compromise between the House and Senate health care bills. But since Scott Brown has won and the Republicans now have 41 votes in the senate, that approach is no longer appropriate. I am hopeful that some Republican senators will be willing to discuss a revised version of health care reform. Because I do not think that the country would be well served by the health care status quo. But our respect for democratic procedures must rule out any effort to pass a health care bill as if the Massachusetts election had not happened. Going forward, I hope there will be a serious effort to change the senate rule which means that 59 are not enough to pass major legislation, but those are the rules by which the health care bill was considered, and it would be wrong to change them in the middle of this process.

“If [Coakley] loses, it’s over,” said Rep. Carolyn Maloney, D-N.Y., before the votes were tallied. Senate Majority Leader Harry Reid, D-Nev., facing his own re-election, was inclined to back burner the ACA, with New York Sen. Charles Schumer, the No. 3 Democrat in the Senate, urging him to move to a jobs bill.

But even on election night, there was at least one politician who wasn’t giving up.

“We don’t say a state that already has health care should determine whether the rest of the country should,” Pelosi said. “We will get the job done. I’m very confident. I’ve always been confident.”

The reaction from White House chief of staff Rahm Emanuel had been the opposite, and he began pushing to back off the ACA and instead do piecemeal reform focused largely on expanding care for children. The White House, Obama included, began sending mixed signals about whether it wanted to go big or small, with Obama endorsing a plan that included “the core elements” of reform.

“I would advise that we try to move quickly to coalesce around those elements of the package that people agree on,” Obama said in one interview.

Pelosi, in a conference call later that month with House leadership, dubbed Emanuel an “incrementalist” and mocked the small-ball idea as “kiddie care.”

The House would be going big, she said. To do it, the lower chamber would pass the version of the ACA that had already moved through the Senate. And the Senate would use the reconciliation process, which requires just 50 votes but is only available for legislation that impacts the budget, in order to make some changes to the original bill.

“I was a mid-level staffer on the Hill during the original ACA fight. I vividly remember the feeling on Capitol Hill the week after Scott Brown won — suddenly the wheels were coming off. People were talking about scuttling a major bill and doing something piecemeal,” recalled Ezra Levin, who would later become a co-founder of Indivisible, a progressive political organization.

He said that he and his eventual co-founder Leah Greenberg, also a Hill staffer at the time, drafted an op-ed they never published, since Pelosi’s push made the issue moot. The unpublished piece argued that “abandoning the ACA would turn off millennial idealists like us from the possibilities of politics. Why work in government, policy, and politics if the result of a generational win like 2008 resulted in barely anything at all? But Pelosi saved it. She demonstrated serious leadership at a time of real uncertainty. It was, corny as it sounds, inspirational. And tens of millions of Americans got health insurance as a result of that leadership in that moment.”

The Affordable Care Act, even the House-passed version, was a flawed piece of legislation, for a host of reasons, some that can be laid at Pelosi’s feet and some that can’t. But as an act of legislative prowess, her revival of it remains a signature accomplishment. 

Just ahead of the final vote, Pelosi sat down with progressive reporters and bloggers for a last pre-passage interview. She relished her victory over Emanuel and the incrementalists. “My biggest fight was against those who want to do something incremental versus those who want to do something comprehensive. We have won that,” she said proudly.

“In our midst, there’s the small-bill crowd — here,” she said, referring to the Capitol, then added, gesturing out the window behind her, where Pennsylvania Avenue stretched to the White House, “and there.”

Effective machine politics are built on rewarding loyalty, punishing betrayal, and a long memory. The tactics translate as well to the House of Representatives as they do anywhere. “No one’s a better vote-counter than Nancy D’Alesandro Pelosi,” quipped Rep. Hakeem Jeffries, D-N.Y., on Friday.

She coupled that understanding of machine politics with the fundraising skills she honed in California, and the eye-popping sum of more than $100 million that she raised for the 2018 cycle helped propel Democrats into the majority.

But her focus on big money contained the seeds of her own political growth away from the left — or, put another way, as the left has developed a sophisticated critique of money and politics and set about building an alternative small-dollar funding infrastructure, Pelosi has stayed moored to big money, the way she knows best.

The extra dose of irony is that she has always used her legislative skill to push hard on campaign finance reforms. If she becomes speaker, HR1 will be a sweeping set of reforms that includes matching federal funds for small contributions, legislation that, if it someday becomes law, could radically reshape the political landscape.

Yet headed into 2019, she has already begun handcuffing a populist agenda and has proposed a rule — called paygo — that any new spending would need to be offset by tax hikes or spending cuts elsewhere. And she has put forward another rule that would require a three-fifths vote for any legislation that increased taxes on the bottom 80 percent of earners, a proposal that would rule out a wide swath of policies aimed at reducing inequality.

Meanwhile, she has taken to ridiculing the push to abolish Immigration and Customs Enforcement and is far from an ally in the fight for “Medicare for All,” urging Democrats instead to focus on reducing drug prices or making health care more affordable, the kind of incremental politics she rightly belittled in 2010.

Yet as she is rocked by a rebellion from her right, she has moved closer to the Congressional Progressive Caucus, which she co-founded with Sen. Bernie Sanders back in 1991. Last week, she cut a deal with the leaders of the caucus that will give progressives proportional representation on so-called money committees — prime slots that have long been reserved for moderate, business-friendly Democrats who use their position on the panel to raise money from the industries under its jurisdiction. Agreeing to such a move was a break from her general mode of operating, which warns that such unilateral disarmament in the fundraising game only plays into Republican hands.

Placing vulnerable moderates in such plum spots, to help them fill their war chests, is a move that Burton would have appreciated. Yet stacking those committees with progressives who will write tougher legislation would likely have made him smile, too. With Pelosi, as it was with Burton, it’s complicated. But this liberal isn’t going down without a fight.

Reporting for this story will be included in a forthcoming book, “We’ve Got People: Resistance and Rebellion, from Jim Crow to Donald Trump.” Sign up here to get an email when it’s published.

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