Obama feared a one-term presidency after passing the health care law

By the time his ambitious health care legislation was introduced, hacked and cursed and left for dead, revived, compromised and passed and finally signed, the whole process had taken its toll on President Barack Obama.

Passage of the Affordable Care Act would be his legislative achievement, but it propelled Republicans to a sweeping midterm election victory and control of the House. And Mr. Obama thought he might be the next to pay the price at the polls. This is shaping up to be a one-term presidency, he told an aide in late 2010.

It turned out to be wrong, but the fatalism Obama expressed privately that day captured the dire consequences of one of Washington’s most high-profile legislative battles in modern times. A new set of oral histories released Friday, on the eve of his 14th birthday Saturday, documents the behind-the-scenes struggle to transform the nations health care system to cover tens of millions of uninsured Americans.

The interviews with key players in the drama were conducted by Incite, a social science research institute at Columbia University, and were released as the second installment of a years-long effort to document the turbulent times under the 44th president of the nations. The transcripts released online Friday included memories from 26 White House staff members, his cabinet and Congress, as well as activists, lobbyists and a handful of Americans who made their voices heard, but not from the former president himself nor, for that matter, his Republican opponents.

Oral histories chronicle Obama’s journey from an uninformed candidate embarrassed by the platitudes he found himself spewing on the campaign trail to a beleaguered president gambling his political future on all-or-nothing legislative acquiescence. They also embody a portrait of Mr. Obama as a constant polemicist, hyper-disciplined but not particularly warm, who surfed the Brookings Institution’s website for ideas and had to overcome his own policy mistakes.

The story of the Affordable Care Act somewhat began at a candidate forum on health care in 2007, when Mr. Obama was running against Senators Hillary Clinton, John Edwards and Joseph R. Biden Jr., among others, for the Democratic presidential nomination. Senator Obama was terrible, recalled Neera Tanden, who worked for Mrs. Clinton at the time. It was useless. He was not comfortable with the subject, so he continued to speak: this is why we must unite.

Mr. Obama knew he had done it wrong, and that prompted him to take the issue more seriously, he said. “Honestly, I think if he hadn’t been kicked, he wouldn’t have come up with such a detailed plan,” Ms. Tanden said.

After Ms. Clinton lost and Ms. Tanden joined the Obama campaign in 2008, he said, many of his advisers thought we should drop this health care issue. He said very clearly: I do health care when I’m president. You guys have to figure out how we succeed in the campaign to build a mandate, but I do.

When he took office in January 2009, Obama tackled a challenge that had vexed presidents of both parties, most recently Bill Clinton, whose first term nearly collapsed after his own failure to pass a broad health legislation. The advisors of Mr. The Obamas were determined to learn from the mistakes of the past.

By developing its own plan in public and involving key players with an interest in the issue, such as insurance companies and congressional speakers, the Obama administration hoped to build support rather than simply generate a plan drawn up in secret in the Congress as the Clintons had done in the 1990s.

The Clinton administration was inwardly focused on the perfect policy and I was a part of that, so I don’t want to seem otherworldly about it, said Nancy-Ann DeParle, a Clinton administration veteran who she became director of the Office of Health Care Reform in the Obama White House. . The Obama administration was the opposite. He was much more focused on stakeholders and people and getting Congress to do the work of debating policy and passing a bill.

But Mr. Obama made his own misjudgments. Ms. Tanden, who became a senior adviser at the Department of Health and Human Services and admired Mr. Obama to pass a radical reform, he said that, however, his team spent an excessive amount of time on smaller issues instead of systemic issues and that he did not initially foresee the big issue would become abortion.

Ezekiel J. Emanuel, a special adviser on health care, who also appreciated that Obama never wavered, said the White House should have sent members of Congress home for their summer recess in 2009 with a slide deck to describe the plan to voters. We didn’t do our job, and I think that was a big mistake, Dr. Emanuel recalled. They needed better tools to tell people.

Peter R. Orszag, the director of the Office of Management and Budget, got a taste of the plan’s misunderstandings and distortions while on vacation that summer in Maine, where he saw storefront signs falsely warning of death panels that they would supposedly be created by legislation.

That was probably the first time it really hit me, he said, just seeing sign after sign about things you can see why people might think that’s where I would go.

Hopes of garnering Republican support all but evaporated after that, leaving Mr. Obama to work only with Democrats. He was deeply involved in the haggling. Kathleen Sebelius, then the secretary of health and human services, recalled a key meeting in January 2010 to reconcile different versions of the plan. The president led those negotiations from start to finish, he said. He was the chief negotiator.

It would eventually happen, but not without painful concessions and legislative machinations. Ms. Sebelius recounted the champagne celebration on the Truman Balcony of the White House last night. Mr. Biden, then vice president, told him: This is the most important thing the president will do for the international community.

She asked what he meant. The world will now know when this young president says, I will do something, that he will do it, Mr. Biden replied.

Even so, Mr. Obama wasn’t sure how much time he would have to do anything else. Ms. DeParle was the aide who recalled that Mr. Obama was thinking about serving just one term as he tried to persuade her to stay in the White House after health care.

I’m fine, he said of a possible four-year presidency, as long as I can do the things I think are important. But Mrs. DeParle found his comment very surprising and thought to herself, Wow, this is my fault.

Ms. DeParle offered some of the ascetic president’s most personal observations. Among other things, he said, he refused to eat in public and only ate at set times each day. When he ate with his staff, you ate with him in silence while he sat reading or preparing for his next event. And their food was almost always the same, whether it was salmon or dried chicken breast, brown rice and broccoli.

Trust me, he said. This was. His only peek to taste? Lemon juice on the side, or something lemony. And never dessert. Food for him is like putting a coin in the counter, he said. He wouldn’t even eat cake, even though he said he liked cake. He doesn’t have any weaknesses that I can tell, he said.

Mrs. DeParle found him a mystery and only came to understand Mr. Obama when he accompanied him to his home state of Hawaii. Waves come in and out, he said. He has a calm demeanor which is just so for me. He doesn’t get too mad about anything. And the fact that it was located so close to Tokyo and New York has an international angle, he added. He sees the world differently than many American presidents.

As it turned out, of course, he had two terms to do so after all. And the Affordable Care Act, for all its flaws and birth pains and Republican efforts to repeal it, is still the law of the land.

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