Evaluating The Legislative Leadership of President Obama During The Process of Passing The Affordable Care Act

By Sara Kalet-Schwartz and Thomas Spinelli

©Photo taken by the White House (Pete Souza)

“That large-heartedness — that concern and regard for the plight of others — is not a partisan feeling.  It’s not a Republican or a Democratic feeling.  It, too, is part of the American character — our ability to stand in other people’s shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.”

Barack Obama – September, 2009

What Are We Looking At?

Legislative leadership in the presidency, as laid out in Article II, Section III of the Constitution, states that the president must direct to Congress the state of the union. This has allowed presidential legislative power to grow, using this duty as a way to express ideas to Congress (“Legislative Role of the President”). Assessing the modern presidency, what is President Obama’s legislative leadership style? In order to assess this, we look at the case study of the passing of the Affordable Care Act (ACA). Healthcare reform is something that must pass through Congress in order to be enacted, and the ACA was the first major healthcare reform bill passed in 45 years. We examine various speeches Obama made to Congress as well as the timing in which the bill was passed with the facilitation of Obama. As a result, we have found that rhetorically, Obama often highlights bipartisan contributions, recognizes the struggles of the American people to pay for healthcare, and patriotically reminds of the greatness of the United States. In terms of timing, Obama encouraged conversations with members of Congress in order to speed up the process without overstepping his boundary. This question is significant because it helps explain the role a president can play that is not explicitly stated within the Constitution, with the exception of the little stated in Article II, Section, III. It helps reveal the impact the president may have on the legislative branch and sets precedent for the modern presidency.

Previous Literature on the Topic

Previous literature has explored the role of the president as a legislative leader. The Legal Information Institute analyzes Article II, Section III of the Constitution (“Legislative Role of the President”). In stating that the president should give Congress an update on the State of the Union as well as having the ability to convene both Houses in extreme circumstances, the Constitution creates an opportunity and duty for the president to express to Congress his/her intents in office. They also explain how the legislative role of the president has grown over the last century, emphasizing how it is due to political and social forces rather than a change in the interpretation of the Constitution. The president is not constrained by the Constitution. 

Some scholars have analyzed the legislative leadership roles of the president over the years. In terms of rhetoric, the president plays an important role in legislation within Congress (Villalobos, Vaughn, and Azari 2012). It was found that political messages appealing to bipartisanship do not have an impact on legislative success. This may explain why President Obama’s attempt at this did not create any bipartisan support for the Affordable Care Act (ACA). Instead, it is the perceived quality of the legislation that the president presents that has an effect on its ability to be successfully passed. In addition, the president’s priority ranking as well as advertisement of those issues had an effect on Congress passing those issues as legislation (Fett 1994). More specifically, there was a positive effect found among members of Congress predisposed to support the president from the start, but there was no effect found among those who tended to oppose the president. This may also reveal why President Obama was able to maintain support from those who originally supported the ACA, but was unsuccessful in obtaining support from those who were not on board from the start for the most part. 

So what about President Obama’s legislative leadership role impacted the ACA’s ability to be passed as a bill within Congress? He noticed the failures of the Clinton Administration and attempted to do the opposite (Oberlander 2010). While he made sure to express his plan within his speeches, he did not overstep his boundaries and allowed Congress to do their job once it turned into a bill to be created and voted on. Still, he pushed members of Congress in an attempt to get the bill through Congress in a timely manner. Lastly, his advice to turn the bill into a reconciliation bill had a major impact as it created only a need for a majority rather than a supermajority, which it lacked due to the failure by President Obama to draw bipartisan support for the ACA.

Rhetorical Strategies Used By Obama

We examined three variables that we considered rhetorical strategies that we found and were prominent throughout President Obama’s speeches on healthcare reform:

  • Bipartisan Contribution: this variable includes recognizing of contributions to and ideas on healthcare reform by members of the Republican party, such as Sen. John McCain, mentioning a need for Democrats and Republicans to come together and throw their party identities away, of which an example can be seen in the quote at the top of the page, and holding members of Congress accountable to get something done (often mentioning Republicans as a group and the disagreements between the two groups that needed to be resolved).
  • Recognition of the American People and their Struggles: President Obama often made a point to recognize the struggles many Americans were facing when it came to having and paying for healthcare. This included referencing statistics of uninsured Americans as well as anecdotes of real people and their stories of struggles under the healthcare system of the time, naming them by name, in order to pull at the heartstrings.
  • Patriotism: President Obama also always made a point to recognize the greatness of the American people and the United States of America as a country. He encouraged the members of Congress and everyone else he was speaking to, ensuring further greatness could be achieved.

Speeches on Health Care Leading Up to March, 2010

  • February 24th, 2009 – “Remarks of President Barack Obama — Address to Joint Session of Congress”: This was President Obama’s first State of the Union Speech around a month after his inauguration. The main premise of this speech was not specifically healthcare reform, so there is not much data to come from it; however, he does make a point to talk about the concept and uses many of his rhetorical strategies within it.
  • September 9th, 2009 – “Remarks by the President to a Joint Session of Congress on Health Care”: This was a speech in which President Obama decided to call a joint session of Congress for. The main and only topic of this speech was healthcare reform. Throughout the speech, he presents the problem and explains why it is a problem, lays out the plan in which he wishes to be put into place, and then hands the responsibilities to Congress to make a plan.
  • February 25th, 2010 – Health Care Summit: President Obama hosted a healthcare summit with all members of Congress to get an opportunity to debate their ideas. The goal of this was to resolve some disagreements and highlight agreements to figure out how to pass a bill everyone could agree on. President Obama gave significant opening and closing remarks, facilitated the discussions, and partook in debate. He emphasized that both sides want something to get done, but the disagreement was how.
  • March 3rd, 2010 – “Presidential Remarks on Health Care Reform”: In this speech, President Obama spoke to an audience of uniformed medical professionals. Similarly to what he said in September, he outlined his proposal and added more, such as his ideas to lower costs and end discrimination of people with preexisting conditions. This was a strategy to show he was working with medical professionals and wanting them to support his ideas in order to put pressure on Congress and get a bill passed.

Our Findings

Rhetoric: Figure 1 is a graph to illustrate the rhetorical aspect of President Obama’s legislative leadership strategy. To do so, we measured the three different common rhetorical strategies used in President Obama’s speeches stated above in terms of how many times he uses each strategy per speech. Examining his first State of the Union address (not shown in Figure 1), he only focused on health care for a short period of time. Still, he managed to call on both “Democrats and Republicans” to begin working on the issue as soon as possible (Office of the Press Secretary 2009). An example of bipartisan rhetoric used in his speeches was to create “a plan that incorporates ideas from many of the people in [the] room… Democrats and Republicans” (Office of the Press Secretary 2009). An example of an anecdote he used to recognize the struggles of Americans was a man who lost coverage mid-chemotherapy treatment due to logistical reasons. A quote that exemplified patriotism was “one of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government.” During the healthcare summit in February 2010, the goal of the day seemed to be more to reach agreement among members of Congress, so Obama refrained from the use of patriotism and upped the utilization of bipartisan rhetoric (“Transcript: White House Health Summit” 2010).

Sources: “Remarks of President Barack Obama – Joint Session of Congress,” The White House, Feb. 2009.; “Remarks by the President to a Joint Session of Congress on Health Care,” The White House, Sept. 2009.; “Presidential Remarks on Health Care Reform,” C-SPAN, March 2010.

Figure 2: Affordable Care Act Timeline

Timing: It is known that once healthcare reform goes to Congress to attempt to be voted in as a bill, the president has no Constitutional power over it. Figure 2 illustrates main events leading up to the bill reaching Obama’s desk in March 2010. Elizabeth Fowler, the chief health counsel to Senator Max Baucus when he was the chair of the Senate Finance Committee at the time, help give input on what Obama did to help facilitate the process (‘A Monumental Effort:’ How Obamacare was Passed” 2020). She stated that it was Obama’s main goal to get a healthcare reform bill passed as quickly as possible. Once the bill hit Congress, he took a step back and allowed them to do their job and not overstep. Still, he would meet with various members of Congress to ensure they were on task. Other things that Obama did can be seen in the timeline to the right, including urging members of Congress to turn the bill into a reconciliation bill, ensuring only the need for a simple majority.

‘A Monumental Effort:’ How Obamacare was Passed.” The Commonwealth Fund. March 2020.; “History of the Affordable Care Act.” eHealth. October 2020.; Historical Timeline – Obamacare – ProCon.org,” Obamacare, 18 Mar. 2020

Final Takeaways

  • President Obama remained true to his various rhetorical strategies, but were they successful? As explained by Villalobos, Vaughn, and Azari (2012), bipartisan rhetoric does not seem to have much impact, and it showed as the votes within the Senate were strictly Democrats for and Republicans agains. With 59 Democrats and a need for 60 for a supermajority, they were forced to turn it into a reconciliation bill, with only 50 votes needed. It is hard to assess whether or not his other two strategies had an impact.
  • While being respectful of the job Congress had, President Obama remained active as the bill bounced from the House to the Senate. Ultimately, the decision to turn the bill into a reconciliation bill was successful, allowing Obama to sign the ACA into existence 14 months after his inauguration.
  • Whether or not his strategies were successful is not clear; however, his administration was the first to see major healthcare reform be passed since the Johnson Administration in the 1960s. Will his actions set a precedent for future healthcare reform and other legislative actions in which the president has a strong stake in?


Feel free to contact us at sgkalet-schwartz@muhlenberg.edu or tjspinelli@muhlenberg.edu.


Fett, Patrick J. “Presidential legislative priorities and legislators’ voting decisions: An exploratory analysis.” The Journal of Politics 56, no. 2 (1994): 502-512.

“History of the Affordable Care Act.” eHealth. Last modified 2020. https://www.ehealthinsurance.com/resources/affordable-care-act/history-timeline-affordable-care-act-aca

“LEGISLATIVE ROLE OF THE PRESIDENT.” Legal Information Institute. Legal Information Institute. Accessed December 8, 2020. https://www.law.cornell.edu/constitution-conan/article-2/section-3/legislative-role-of-the-president

“Medicare and Medicaid.” LBJ Presidential Library. Last modified 2020. http://www.lbjlibrary.org/press/media-kit/medicare-and-medicaid.

Obama , Barack. “Transcript: White House Health Summit, Afternoon Session.” Kaiser Health News, February 25, 2010. https://khn.org/news/summit-transcript-afternoon/.

Obama , Barack. “Transcript: White House Health Summit, Morning Session.” Kaiser Health News, February 25, 2010. https://khn.org/news/health-care-reform-transcript/.. 

Oberlander, Jonathan. “Long time coming: why health reform finally passed.” Health Affairs 29, no. 6 (2010): 1112-1116.

Office of the Press Secretary. “Remarks of President Barack Obama – Joint Session of Congress”. The White House. Last modified 2009. https://obamawhitehouse.archives.gov/the-press-office/remarks-president-barack-obama-address-joint-session-congress

Office of the Press Secretary. “Remarks by the President to a Joint Session of Congress on Health Care”. The White House. Last modified 2009. https://obamawhitehouse.archives.gov/the-press-office/remarks-president-a-joint-session-congress-health-care

“Presidential Remarks on Health Care Reform.” C-SPAN. Last modified 2010. https://www.c-span.org/video/?292351-1/presidential-remarks-health-care-reform

Procon.org. “Historical Timeline – Obamacare – ProCon.org.” Obamacare. Last modified 2020. https://www.healthcarereform.procon.org/historical-timeline/

Seervai, Shanoor. “‘A Monumental Effort:’ How Obamacare was Passed.” The Commonwealth Fund. Last modified 2020. https://www.commonwealthfund.org/publications/podcast/2020/mar/monumental-effort.

Villalobos, José D., Justin S. Vaughn, and Julia R. Azari. “Politics or Policy? How Rhetoric Matters to Presidential Leadership of Congress.” Presidential Studies Quarterly 42, no. 3 (2012): 549-576.