T
Chapter 3: The Hard Work of
Reform
he first term was a gauntlet. We pushed through the
American Recovery and Reinvestment Act, but the real
shadow was the fight for healthcare. For decades, presidents had
tried and failed to reform our system. I knew the political cost
would be high—perhaps even costing us the midterms—but the
stories of people being denied coverage for pre-existing conditions
made it a moral imperative. Simultaneously, I was navigating the
'Surge' in Afghanistan and the complexities of the Arab Spring. We
were rewriting the American social contract while recalibrating our
role on the global stage, often under a barrage of unprecedented
partisan opposition.
Historical Note: The ACA Legacy
The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23,
2010, represented the most significant regulatory overhaul of the U.S. healthcare
system since the passage of Medicare and Medicaid in 1965.
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