“When Barack Obama ran for president, he faced a choice. He could continue moving the party to the center or tack back to the left. The second option would have focused on government programs, like expanding Medicare to start at age 55. But Obama and his team thought a plan that mixed government and markets — farther to the right of Clinton’s — could cover millions of people and had a realistic chance of passing.
They embarked on a bipartisan approach. They borrowed from Mitt Romney’s plan in Massachusetts, gave a big role to a bipartisan Senate working group, incorporated conservative ideas and won initial support from some Republicans. The bill also won over groups that had long blocked reform, like the American Medical Association.
But congressional Republicans ultimately decided that opposing any bill, regardless of its substance, was in their political interest. The consultant Frank Luntz wrote an influential memo in 2009 advising Republicans to talk positively about “reform” while also opposing actual solutions. McConnell, the Senate leader, persuaded his colleagues that they could make Obama look bad by denying him bipartisan cover.”