Symbol of National Health Care: Obama Administration (left) and Tea Party Movement (right)

Overview

The U.S. Healthcare Reform, commonly known as Obamacare, refers to the legislation of Patient Protection and Affordable Care Act (PPACA) and Health Care and Education Reconciliation Act (HCERA) that were signed into law by U.S. President Barack Obama in March 2010. The constitutionality of PPACA was subsequently challenged by a majority of the U.S. states and organizations in federal court, which came to a closure on June 28th, 2012, when the U.S. Supreme Court ruled that the mandate was a tax and therefore fell under Congress' taxing authority.

Background

The modern health care reform efforts in the United States began with the federal enactment of Medicare and Medicaid programs under the Lyndon B. Johnson administration in 1965. While numerous initiatives towards universal health care coverage have been proposed under several administrations spanning over the past decades, the public interest in health care reform reached its pinnacle as one of the main policy issues during the 2008 presidential campaign. The then-presidential candidate Barack Obama was among the most progressive advocates of universal health care and upon entering the office, it became one of the most critical and high-priority policy initiatives under his administration.

Notable Developments

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Shortly after winning the election in November 2008, the newly elected President Obama launched the website Change.gov, where public opinion regarding the health issues became one of the first major discussion topics on the site. The survey post, which asked "What worries you most about the healthcare system in our country?", went onto receive more than 2,200 comments within the first 24 hours.

2009: Tea Party Protests

During the congressional summer recess in August 2009, members of the Tea Party movement rapidly mobilized around the issue of the proposed health care reform bills and organized protests online as well as at the congressional town hall meetings. Meanwhile, conservative bloggers across the country dubbed the reform initiative "Obamacare" and characterized his political ideology as Socialist, a label that is still considered scandalous in the United States politics. On August 6th, 2009, YouTuber DougFromUpland uploaded a Hitler's reaction video titled "HITLER RANTS ABOUT OBAMA HEALTHCARE AND RIGHT WINGERS," (shown below, left) which has received more than 226,000 views as of July 2012.

[This video has been removed]

As the Congress prepared to reconvene in September, advocates of the reform launched a grassroots social media campaign on Facebook to shape the public opinion regarding the bills. On September 9th, President Obama delivered an address about the health care bill before a joint session of Congress, during which the Rep. Joe Wilson interrupted his speech by yelling "You lie!" More than 880,000 Facebook status updates demanding the health care reform were posted within 24 hours, according to CNN's column article published on the same day. On September 13th, YouTube channel FreeYourPixels uploaded a video comparing Wilson's holler to rapper Kanye West's interruption of Taylor Swift's speech at the 2009 MTV Video Music Awards.

2010: Legislation and Constitutional Challenge

In March 2010, after months of deadlocked debate between the Republicans and Democrats, both Houses passed the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA), which were signed into law by President Obama on March 23rd and 30th, 2010, respectively. However, Republicans and other critics of the reform continued to contest the law's constitutionality, keeping the national debate well alive and feeding anti-Obamacare slogans for the Tea Party members.

2011: Occupy Protests

Throughout the year, the constitutional challenges over the health care reform continued in both state and federal courts. In September 2009, a series of sit-in protests known as Occupy Protests began to emerge across major U.S. cities, which brought students and progressive minded Americans together in displaying their support for universal health care coverage.

2012: Supreme Court Review

In November 2011, the U.S. Supreme Court began reviewing the case of National Federation of Independent Business v. Sebelius, which represented a number of related state-level cases that had been filed against PPACA and HCERA by numerous parties.

#IWantRepeal Campaign

With the U.S. Supreme Court's ruling on President Obama's health care law less than a month away, National Republican Congressional Committee (NRCC) unveiled a social media campaign using the hashtag #IWantRepeal on June 7th, 2012. The campaign was launched in the form of single topic blogs on Twitter and Tumblr^[23], where people could submit their signatures with the hashtag and see their names printed onto paper petitions in real time via Ustream. The group also released a quick-paced YouTube video with instructions to participate in the hashtag campaign.

At first, the hashtag campaign against the healthcare bill seemed to be taking off with valid signatures, but shortly after its launch, the political news blog Wonkette^[24] published an article titled "Everyone Must Spam GOP's Anti-Healthcare Reform Livestream Thing Immediately," which apparently inspired its readers to visit the NRCC's blog and spam the printer with irreverent signatures. Soon enough, the petition came under the invasion of trolls who sought to derail its message by submitting fake signatures, which were then printed onto the paper and streamed in real time.

According to various witness accounts, the trolls managed to flood the printer with their submissions for approximately 10 minutes before it came to a halt with the anticlimactic signature "Bruce Dackler." Following the conclusion of the livecast, the story was picked up by internet news sites like Wired, Gawker and BuzzFeed, as well as blogs and discussion forums such as The Democratic Underground, BarStoolSports Forum and GameFAQ among others.

American Health Care Act of 2017

On January 20th 2017, hours after the "inauguration of Donald Trump":knowyourmeme.com/memes/events/inauguration-of-donald-trump, President Trump signed his first executive order proclaiming the adminstration's mission to seek the prompt repeal" of the Affordable Care Act as a top priority agenda, as well as directing the heads of several federal agencies to "waive, defer, grant exemptions from or delay implementation of any provision or requirement" of Obamacare as loosely as allowed by the law.

On March 6th, Republicans in the House of Representatives introduced a bill that would serve as the first initiative of a three-phase plan to repeal the Affordable Care Act, formally known as the American Health Care Act of 2017 (AHCA), though it quickly became commonly referred to as Trumpcare^[33]. The bill sought to revoke the federal component of Obamacare, including tax provisions and employer mandates contained in the Internal Revenue Code, as well as modifications to the federal Medicaid program. That same day, Twitter became awash with a series of jokes comparing Obamacare and Trumpcare using two images (shown below)

On March 20th, after passing through a series of committees in the House, a vote on the bill was scheduled for March 23rd. In the following days, several hashtags, including #healthcare and #trumpcare, began trending on Twitter^[32] and elsewhere on the social media as the public debate ensued in reaction to the bill. On March 23rd, the Trump administration officials released an ultimatum suggesting that the country will be "stuck with Obamacare" indefinitely unless the bill passes through the House on the next day. On March 24th, the House speaker Paul Ryan withdrew the bill with continued opposition from both moderate and far-right Republican legislators.

House of Representatives Passes AHCA

On May 4th, 2017, The United States House of Representatives voted 217-213 to pass the American Health Care Act.^[34] The bill was a tweaked version of the earlier bill that never went to a vote. In the bill, young and affluent healthy people would receive a break as they would be paying less for subsidies to the sick and elderly. Experts believe the bill will result in millions losing their health care coverage and that 24 million Americans could find themselves uninsured by 2026 if the bill becomes law.^[35] Furthermore, a new amendment, known as the MacArthur amendment, allows states to request permission to opt-out of several Obamacare restrictions, including its popular ban on discriminating against people with pre-existing conditions. The passage of the bill was seen as disastrous for the elderly, as the bill cuts $880 billion from Medicaid,^[36] as well as women, as sexual assault, domestic abuse, and pregnancy would now be seen as "pre-existing conditions." Included in the bill, however, was an exemption for members of congress to keep the popular protections the Affordable Care Act covered that the bill eliminates.

As it stands, the bill is expected to have a difficult time passing the Senate, where it needs a simple majority of votes to become law.^[37] As the voting finished, House Democrats were reported to be singing "Na na na na, hey hey hey, goodbye" to Republicans, as they believed the passage of the unpopular bill would be disastrous towards House Republicans in the upcoming 2018 midterm elections.^[38] Online, the passage of the bill was met with great displeasure. On Reddit, a thread in /r/politics^[40] linking to an Independent article titled "Pregnancy to cost 425% more under Donald Trump's health plan compared to Obamacare" gained over 45,000 points.

Scootering Jason Chaffetz

Before the vote, House Oversight Committee Chairman Jason Chaffetz was photographed rolling on a medical scooter to vote on the bill, as he had recently gotten out of surgery.

Twitter users mocked the photo, often pairing it with On My Way To Steal Yo Girl text. Many also noted the hypocrisy that Chaffetz was getting out of a surgery that was necessary for a pre-existing condition he had, and he was voting on a bill that would make care for those with pre-existing conditions much more difficult. The jokes were covered by The Daily Dot.^[39]

Online Reactions

After months of oral argument and hearings throughout the first half of 2012, the Court upheld the validity of the individual mandate in PPACA, thus leaving the core principles of the reform legislations unaffected. The news of the Supreme Court's ruling was met by split reactions from both the Republicans and the Democrats, as well as inspiring celebratory image macros and blogs from the proponents of health care reform, such as Affordable Care Cat^[1] and Hey Girl Affordable Care Act^[2] Tumblr blogs.

"No One Should Die Because…"

In September 2009, a copypasta message advocating the U.S. healthcare reforms began circulating on Facebook, which read:

“No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, post this as your status for the rest of the day”.

According to Facebook's research and analysis of the meme, the copypasta apparently had a resounding impact across the network, prompting more than 470,000 users to post this statement as their status update in verbatim and spawning 121,605 different variants of the phrase in 1.14 million status updates over the following two years.

While some of the earlier variants of the phrase were marked by minor changes in word choices with little effect on the meaning of the message, as time went on, other incarnations with drastically different messages began to emerge, including a Star Wars-inspired parody ("No one should be frozen in carbonite, or be slowly digested for a thousand years in the bowels of a sarlacc, just because they couldn’t pay Jabba the Hut what they owe him. If you agree, post this as your status for the rest of the day.") and an anti-joke about cancer patients ("No one should have to worry about dying tomorrow, but cancer patients do").

Furthermore, despite its beginning as a show of support for President Obama's healthcare plan, the meme eventually became re-appropriated by the critics and detractors of Obamacare in the conservative camp, some of the more notable examples being "no one should die because Obamacare rations their healthcare" and "no one should go broke because government taxes and spends."

#ObamacareInThreeWords

In June 2012, Republicans and conservatives on Twitter began using the hashtag #ObamacareInThreeWords to voice their opposition against the healthcare reform bill, including the Speaker of the House John Boehner (shown below). The hashtag enjoyed a brief period of widespread use among the detractors of the healthcare reform, however, it soon faded into oblivion following the re-election of President Barack Obama for a second term.

#fullrepeal RT <a href="https://twitter.com/gopwhip">gopwhip</a>: <a href="https://twitter.com/search/%23ObamaCareInThreeWords">#ObamaCareInThreeWords</a> --&gt; We. Will. Repeal.</p>&mdash; Speaker John Boehner (SpeakerBoehner) June 29, 2012

Then on May 16th, 2013, the White House responded to the House Speaker John Boehner's call for its repeal on Twitter, using the same hashtag and a picture of President Obama's signature on the bill. According to ABC News, the delayed response from the White House came as Republican congressmen planned to vote for the repeal of Obamacare on that day, which marks the 37th attempt since the bill has passed in March 2010.

It's. The. Law. #ObamaCareInThreeWords, twitter.com/whitehouse/sta…

— The White House (@whitehouse) May 16, 2013

The hashtag soon became one of the globally trending topics on the site, spawning a wide range of three-worded responses from others who either supported or criticized Obamacare.

So. Was. Slavery. RT <a href="https://twitter.com/whitehouse">whitehouse</a> It's. The. Law. <a href="https://twitter.com/search/%23ObamaCareInThreeWords">#ObamaCareInThreeWords</a></p>&mdash; Right Scoop (trscoop) May 16, 2013

#ObamaCareinThreeWords Still largely unread.

— Popehat (Popehat) <a href="https://twitter.com/Popehat/status/335170669622992896">May 16, 2013</a></blockquote> <script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script> <blockquote class="twitter-tweet"><p>Way. Over. Budget. <a href="https://t.co/aofFxD35p1" title="http://m.washingtonexaminer.com/cbo-obamacare-costs-double-to-1.8-trillion-in-first-decade/article/2529655">m.washingtonexaminer.com/cbo-obamacare-…</a> <a href="https://twitter.com/search/%23ObamacareInThreeWords">#ObamacareInThreeWords</a></p>&mdash; Dana Loesch (DLoesch) May 16, 2013

Not single payer. #ObamaCareInThreeWords

— Dan Savage (fakedansavage) <a href="https://twitter.com/fakedansavage/status/335122144960860160">May 16, 2013</a></blockquote> <script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script> <blockquote class="twitter-tweet"><p>Ice cold beer <a href="https://twitter.com/search/%23ObamaCareInThreeWords">#ObamaCareInThreeWords</a></p>&mdash; CollegeHumor (CollegeHumor) May 16, 2013

Senator Ted Cruz' Speech

On September 23rd, 2013, the day before the Congressional vote on a funding bill for the U.S. Healthcare Reform, Texas Republican Senator Ted Cruz staged a lengthy speech on the Senate floor in a last-minute attempt to shore up support against its passage (shown below).

The speech, which began at 2:41 p.m. (ET) and went on uninterrupted for 21 hours until noon on the day of the vote, consisted of the usual rhetorics against big government spendings, but as hours passed, Cruz resorted to a number of interesting metaphors to criticize the bill, including comparisons of his own grandstanding to the mission to the Moon and Washington D.C. to the Star Wars Galactic Empire, while likening his opponents to the British appeasement of the Nazi party. Although Senator Cruz' speech was largely ignored by the Democrats as a self-serving publicity stunt and met by lukewarm responses from fellow Republicans, the one-man protest against Obamacare was widely covered by the U.S news outlets and met by satirical response on Twitter (shown below).

The 2013 Healthcare Budget Crisis

Throughout the month September, the stalemate in Congres continued on without a bipartisan compromise, and by October 1st, all “non-essential” civil services provided by the United States federal government had been placed on temporary suspension, resulting in the United States government shutdown for the first time since 1995.

Healthcare.gov Launch Failure

On October 1st, the official healthcare insurance marketplace for U.S. citizens (Healthcare.gov) went live, despite coinciding with the first day of the government shutdown. However, the website soon crashed after receiving more than 1 million visitors in less than 24 hours of launch, with the marketplaces for residents of Maryland and California, among many others, becoming completely unusable.

Obamacare Girl

As the website's malfunctions and glitches continued through the latter half of October, an image of a smiling woman prominently displayed on the homepage soon became the scapegoat of the launch failure, inspiring a slew of late-night talk show satires as well as online mockeries.

On October 21st, The Onion highlighted the woman in an article titled "People In Healthcare.gov Stock Photos Now Visibly Panicking,"^[24] featuring a photoshopped image of the woman with a frightened facial expression (shown below). In the following days, the mysterious woman became dubbed the "Mona Lisa of Health Care" in the political blogosphere and news media, as well as drawing attention from online discussion forums, before it was replaced with another image on October 27th.

On November 13th, the woman in the photograph appeared in an exclusive interview with ABC News Good Morning America^[25] to discuss the ordeals of her newfound fame as the face of Healthcare.gov. The woman, who only wishes to be identified by her first name "Adriana," also asserted that she has become a victim of cyberbullying as a result of the unwanted association with the website.

"The saga of the photo started innocuously enough. Seeking free family photographs, Adriana emailed a contact at the Center for Medicare and Medicaid Services, the agency responsible for the Affordable Care Act's rollout, about having photos of her and her family taken in exchange for allowing the photos to be used to market the new health care law. She was never paid."

Pajama Boy

On December 17th, Barack Obama tweeted^[16] a link to a promotional website for #GetTalking, a social media campaign aimed at encouraging young Americans to discuss healthcare policies, along with a holiday-themed advertisement featuring a young adult male dressed in flannel pajamas with a coffee mug in his hands. Both the website and the advert were created by the nonprofit social welfare group Organizing For Action.

Within minutes of the post, President Obama's sponsored-tweet was met with ridicule and parodies from the critics of healthcare reforms and conservative bloggers, many of whom poked fun at the model's onesie pajama suit while others criticized the campaign as an ostensible attempt to drive up support for Obamacare in the millennial "hipster" demographic.

Brosurance Ads

On October 22nd, 2013, several Colorado Obamacare registration ads were released online as part of the "Got Insurance?"^[22] campaign by the Colorado Consumer Health Initiative (CCHI) and ProgressNow Colorado Education organizations. One of the ad posters featured a photograph of two men holding up a man performing a "keg stand" beer-drinking maneuver (shown below), with the caption "Brosurance" (shown below).

That day, several news sites published articles mocking the new brosurance ad, including BuzzFeed,^[26] CNN^[25] and the Huffington Post.^[24] Also on October 22nd, Redditor CommanderpKeen submitted the brosurance ad to the /r/cringepics^[23] subreddit, where it gained over 340 up votes and 50 comments in the first two months. On January 7th, Got Insurance? released a new ad featuring a woman standing with actor Ryan Gosling accompanied by a "Hey Girl" insurance description (shown below).

On January 8th, the Daily Show aired a segment mocking the brosurance ad, which included an interview with Got Insurance? director of strategic engagement for CCHI Adam Fox (shown below).

Search Interest

External References

law legislation obamacare health care controversy