Bart Stupak, A Year After Health Care: Getting 'Bitched Out' in Airports, How the Deal Went Down, and More

Former congressman Bart Stupak was the lynchpin of health reform's passage, and he paid a price for it in the end.

The pro-life, Michigan Democrat led a small but powerful bloc of Democratic lawmakers to oppose the bill because of its language on federal funding of abortions. Seemingly at the last minute, Stupak and the White House hammered out a compromise, his pro-life allies supported the bill, and it passed by a thin margin.

After that, Stupak received a death threat. Facing outside spending in his district and a vitriolic political climate, he decided not to run for reelection. Now, he's a visiting fellow at Harvard's Institute of Politics.

On health care reform's first birthday, Stupak told The Atlantic about getting "bitch[ed] out" by angry citizens in airports, how he and President Obama reached the deal that secured the bill's passage, and that Rahm Emanuel knows better than to get in his face.

A lightly edited transcript, with some questions and parts of answers excised:

How do you look back on health care reform now, as a time in American politics and as a moment in Congress?

Well it certainly was a historic debate. It wasn't Congress's best time, especially when you had people like some Republican members off the Speaker's Lobby urging protesters on the ground--I thought that was unbecoming of members of Congress--and you know members were spit on and threatened as they walked over to vote. I don't think that was a very glorious moment in our history, but from a historical point of view the health care legislation is historic. It's the law of the land, and it's being implemented. And I find it amusing that even states that declare it unconstitutional are implementing it.

Are you still a supporter of the law?

Oh, absolutely. It's not the most perfect law, and there's going to be changes--we all know that--but, boy, it's a good foundation from which to build off.

What do you think, specifically, could change about it?

Well I'm sure as they go through, states will do different things. Some of the states have asked for--I don't want to say exceptions, but a waiver because they already do this part of that part, so I expect there's going to be some changes along those lines. One of the changes I see with all these things on collective bargaining, whether it's Wisconsin or wherever, if the employee's paying part of it, and the employer, being the state or whoever it is, is paying part of it, I could see them trying to spread that cost around, so you don't hit that 'Cadillac plan' insurance, which goes into effect in about 2016 I think it was, so I see some changes going on there. The challenges to the constitutionality of it, I don't see that as being threatening to it. And as with anything else, like with Medicare, there will be some changes to it.

Do you have any regrets over how it all went?

No. Nope, I always ran on health care, I did not take the federal employee health benefits package, I thought all Americans should have it before I accepted their package of benefits. I always felt strongly about health care. In fact, since the whole debate, you go back and you look at some history as I have, especially since I decided not to run again, I got an article from December of 1992 and the headline was, "Stupak's Top Priority: Health Care."

Here's a separate question from whether it's a good law: Was it good for Democrats, politically, that health care passed?

I had no trouble selling health care in my district. Some members ran from it after it passed, because people were not happy with it. I still find today, yet, a lot of confusion about the law. In fact, my wife and I hosted Menominee County Democrats at our house, and their speaker was Senator Carl Levin, and there were quite a few people there, and these were Democrats mostly, and even they were confused. Like, you know, my son's disabled and he works at a workshop and makes $9,000, you know, how's he going to afford the new health care law? Well, he won't have to worry about it. He's going to be 100 percent subsidized. 'Well, I didn't know that,' they'd say.

When you start talking about the patients' bill of rights and all the benefits that are in there, people agree with all that. What they don't know is how are you going to pay for it. I'm going off the top of my head here, but it seems to me that the law would generate, over 10 years, $1.8 trillion, and the cost was about $920 billion. There was like $160 or $190 billion going towards deficit reduction. People do not realize that because most members don't articulate that.

I actually went around my district from before the [first] vote in the House and all the way through up until the final vote in March, and people would come back after going through a town-hall meeting, after seeing the slide presentation I did, they'd say, 'Well, that makes a lot of sense.' And they weren't that angry about it. You still get people who say, 'Well, I don't want to pay for it.' Technically, you don't have to. You're going to get a little 2.5 percent charge to help pay for the infrastructure, and they object to that, but yet they want the ambulance, the EMTs, the emergency room to be there when they get hurt. So when you put it like that, they say, 'Yeah, okay, I understand that, but I don't like it.' Okay, fine. And I don't like having to pay about $1,017 a year for the uninsured that is applied to my premium.

If I would have run, I just wish Democrats would have stayed with it, and when you look back, we passed this March 21, and what's the next thing that happened that sucked the headlines? No matter what the president or anyone tried to do on health care, they never got the headlines, because the Gulf oil spill happened. It seemed like it sucked the wind out of the whole health care debate. It's like--I feel bad for President Obama right now. The economy is getting better, and everyone's saying that, and the market's doing well, and then what happened? Japan.

I spoke last night to the Republican club here ate Harvard, and we talked about health care. And there were some challenging questions, but when we got all done, even the kids there said, 'Man, you know your health care stuff.' I said, 'Yeah, I lived through it, so I'm going to.' So I know it fairly well, and they thought it made some sense. There's parts of it they don't like. I agree, there's parts of it I don't like.

Looking back at the headlines the day after President Obama signed the law, some of them were about you receiving a death threat.

The case is still pending. The guy has now petitioned the court, and motions were granted to allow him to get psychiatric evaluation.

Have you encountered anything like that since, or any anger?

Oh yeah. I still get accosted. It's been amazing to me how many people come up and say, 'I should know you.' And I'll say, 'Where are you from?' They'll say, 'Oklahoma.' And I'll say, 'Eh, you probably don't know me then.' And they'll say, 'Yes, I should.' And someone else will say who I am. And someone will come out and just bitch me out. Others will come up and shake my hand and say 'congratulations' or something, 'we needed it.' Fortunately, I get more pats on the back than people cussing me out. It's not unusual that when I go through an airport--and I go back and forth every week--that I will get at least one person cussing me out.

How do you handle that, when it happens?

It was a good bill. Proud to have voted for it. And then that just gets their anger going, but I'm not going to get in an argument with somebody in an airport--that's ridiculous. I just, you know, say 'have a good say,' move on.

You were a central player in the abortion fight. You supported the Hyde language throughout, and then at the last minute it passed on the agreement that President Obama would issue an executive order clarifying the language that was in the bill. Do you still feel that executive order was enough to live up to your expectations on abortion policy?

Yes, because the president has had three opportunities to throw us under the us, if you will, and he has not. Number one, in the high-risk pools. Remember how New Mexico send theirs in and had abortion in there, and Right to Life and all of them jumped right on it, and [Health and Human Services Secretary Kathleen] Sebelius and all of them said, 'Wait a minute, you can't do that. We had an executive order.' They changed their law. So did Pennsylvania. So in order to apply for the high-risk pool, their law had to be reflective of the executive order, which says no public funding for abortions. They held firm to it.

Secondly, the community health centers, which the law was silent on. The executive order says you cannot perform abortions or advocate for them in public health centers. That has been upheld.

And, last but not least, there's a number of grants you can apply for right now, especially for developing health care professionals--that's going on right now in the bill--and if you go online and look at the applicaiton form, it says you must comply with the Hyde language, even in your application for the use of these federal funds. So there have been three opportunities for Secretary Sebelius or Presient Obama to just sorta look the other way, and they haven't. They've upheld it. So there have actually been less abortions now because of that executive order and the health care bill than there would have been if we'd never had it.

What was it like dealing with the White House and dealing with Democratic leaders through all that? People kind of assume there must have been a lot of pressure, a lot of brow-beating. What was your experience like?

No. The White House, the president? Never really spoke to me about it. Remember when the president spoke in September 2009, when he add Congress on health care, and when [Rep. Joe] Wilson shouted out 'you lied!' and all of that? In there, the president also said that there should be no public funding for abortions. I wold talk to him after that about what he said, and that I was going to hold him to his word, 'cause for a lot of us we couldn't support it if that wasn't going to be the case, and he asked me to continue to work with leadership and work it out. And after that conversation, we did a lot of work with leadership, but we just couldn't work it out--well, we had the Stupak amendment in November.

But then, after that, I spoke to the president maybe a week before the vote. I was at the White House for a bill signing ceremony on a bill we had done some things on. He just says, 'Hey, I really need your help to get this thing passed.'

And I said, 'I'd really like to help you Mr. President, but, you know, I have a hang-up, and I believe in health care for all people, but I have a hang-up with the abortion part.' He said, 'Well, we gotta work that out.' I said, 'I don't know how we're gonna, but we'll somehow work it out.' And so that was all the pressure I had. I had more pressure from like Rahm and other White House--

That seemed to be the White House M.O. at the time, for Rahm to be the hammer and for Obama to be the big picture guy--at least that's how it looked to me.

Yeah, and that's how they played it with me. And some of the secretaries, like [Secretary of Labor] Hilda Solis, who I know well, Sebelius had called--you know the normal calls. But it wasn't heavy pressure.

Was it unpleasant talking to Rahm? Everybody thinks he's just a screamer and shouter and would just wave his fists around--

No, Rahm doesn't scream and shout at me, 'cause he knows better. I'll just tell him to go to Hell and move on. No, no. rahm and I had a couple of good conversations. The executive order came up in the conversations we had a few weeks before it ever came.

But, to be honest with you, I'd been working with some of the Senate Republicans on trying to find some way to do a technical corrections bill. And actually, truth be known, the Republican leadership in the Senate pulled the rug out on me on that on Thursday night, the Thursday before that Monday [when the final vote occurred]. Most people don't realize that.

Anyways, long story short, I always thought we would have some statutory language. It wasn't until Thursday before the vote that when the Republican leadership on the Senate side said no go ... and the reason was that it would pass.

Health care would have passed the Senate with Hyde language?

Yeah. It would fly though the Senate. So they weren't interested in getting health care passed, they were interested in killing it. So every suggestion, every legislative proposal I had--and I knew I had to get to 60 votes in the Senate--I was led to believe up to that point in time they'd work with me. And they pulled the rug out that Thursday before. Remember, they went home that Thursday night, or that Friday night there. They weren't around that weekend when we voted on the health care bill.

Right. They were gone, and House Democrats were meeting in the Capitol Visitors Center, and that's when all that craziness was happening on the Hill.

I'll tell you what happened was, the White House started to float an executive order, but I was not included in the discussions. And the group that stood with me, about 12 of them that were with me, only about 7 at the end, they came back and they said to the White House, 'We're not negotiating an executive order without Stupak.' And then what happened was, the White House--they tried to do an end run around me.

They tried to work out a deal without you involved.

Right, without my adamant position. But fortunately I had the faith of these people, and they said, 'We're not doing it without Stupak.' And then what happened was, you know [Rep.] Mike Doyle [(D-Pa.)], he's probably my best friend in Congress, said, 'Okay what do you need in this executive order?'

I said, 'Well Mike, how'd you get involved in this?' He said, 'Well, let's just say I was at this meeting, and it's not going anywhere unless we get you on board.' And I said, 'I could've told you that, saved you some meetings.' And when it came down to it, they said, 'Look, Stupak, you know this issue forwards and backwards, you draft the executive order, or draft the points you have to have in the executive order.' That's how it started.

And then we met outside the White house. The White House, everyone was watching the White House, everyone was watching what we were doing. So we met, Rahm wasn't there, [White House Director of Legislative Affairs for the U.S. House] Dan Turton really was the guy, and Greg Craig, the president's [now former] counsel, and we met in some little anterooms off Doyle's office, in [the] Cannon [House office building]. ...

This is either Thursday or Friday night. After Doyle said, 'What do you need in this executive order, you put down what you would like to see in this executive order,' I spent that afternoon after Republicans left, we had some votes, I went back to my office, drafted about six points, gave it to Doyle, he gave it to the White House, and then White House counsel put together a draft, and it was either that Thursday night or that Friday night and we met, at the Cannon building in some little conference room. We met Friday night, Saturday night, Sunday.

So we did it outside the limelight. Rahm was never there, the president never was there. The only time I talked to the president then was maybe about two or three or four o'clock in the afternoon on Sunday. Sunday morning we had met on the executive order again, I gave my final approval on Sunday morning, the president called about four o'clock--there was some minor change I made, with that change he was going to sign it, and could I then vote for the legislation? I said yes. And how many of my people would be [on board]--about seven of us, which then guaranteed they'd get this thing passed.

And so that was it. I never really had any discussions with the president directly on the executive order, other than working with his counsel, and there were about three attorneys there, and I was the lead on the other side.

When we met, like Friday, there had to have been about six of us, Sunday were six of us, Saturday there was about six of us, but I was the lead on it. That's the way the whole thing came down. I know there are all these other theories, but they're not correct.

At the time it looked like it happened right at the last minute. Sounds like the deal got worked out a couple days ahead of time.

Yeah. Again, on the first draft of the executive order, they didn't include me in the meeting. And these people came back to me, some of my stalwarts ...

I had the confidence of the Right to Life Democrats--I had been the leader for many years, and I know the stuff cold--and they said, 'You're the guy that has to do it, it's not going to be anyone else,' and so we worked it out. There was a lot more involved, but up till the Thursday before that vote, I was still trying to get statutory language. But when the Senate Repubs sorta packed up the tent and went home, they really left me with nothing but an executive order. ...

I made the tweak Sunday morning, and what happened was...[President Obama's] attorneys then had to go sell the pro-choice groups, and I know they spent late that Sunday morning, early Sunday afternoon, going over it with the pro choice groups. And they called and they said, 'We're going to go with your language that we finalized earlier today.' I said, 'Okay,' and they said, 'We can't really speak for the president, the only one who can really do that is the president. We will present it to him, and we'll let you know what the decision is going to be.'

And it had to be closer to four o'clock, the president called me and said, 'I'm going to sign this executive order, I'm in agreement with you.' So I told the president really, the people who won in this matter was not me or him, it was the American people. And we did it for the good of what I believ is best for the American people. That's how we got health care.

I guess he agreed with you.

And I give him credit. I've called him and told him, 'Thank you.' He's upheld that executive order. When he signed it, he said this was an ironclad commitment--those were his words, 'ironclad commitment,' and I'll give him credit. He's done it. I say that maybe with a little bit of surprise in my voice, I always thought he would, but there was so much outrage from the Bishops and Right to Life that, 'How could we trust this president, cause he's the--' I hate to use the word--but 'the most pro-abortion president ever, and you can't trust him.' Well, I trusted him, and that trust was well founded.