Eight Years of Science Under Obama: Boom or Bust?

JOHN DANKOSKY: This is Science Friday. I’m John Dankosky. Ira Flatow is away. It appears as though political support for scientific research, climate change, and the space program might be a bit scarce over the next four years, and that’s a big change from the last eight years. Even with big questions about some of the policy outcomes, the reputation of science has flourished under the Obama administration. The president supported the advancement of science through legislation, through appointments, executive actions, and diplomacy.

But which of these efforts will have a long-lasting impact? We’re going to ask some policy experts in a moment, but first we’ll turn to what was to be the cornerstone of the Obama legacy, the Affordable Care Act, otherwise known as Obamacare. Republicans have placed the controversial healthcare law on the chopping block. Just this week Congress held a procedural vote that paved the way for repeal of Obamacare. But is a full tear-down of the ACA even possible? And what does replacement look like?

Here to fill us in on what might happen to Obama’s healthcare legacy in the months ahead is my guest Sarah Kliff, senior editor covering health care for Vox Media. She joins us via Skype. Sarah, welcome to Science Friday.

SARAH KLIFF: Thank you so much for having me.

JOHN DANKOSKY: So first of all, give us the latest on the repeal. What exactly is happening right now in Congress?

SARAH KLIFF: A lot of confusion is what I would say is happening. So Republicans definitely want to repeal and replace Obamacare. They have run on this promise for six years now. But actually doing that is turning out to be quite a challenge.

You see a lot of space between what President-elect Trump wants to happen, what Republicans want to happen in terms of the procedure. Basically when they do the repeal, when they do the replace. There is a lot of agreement in the Party. They want to get rid of Obamacare and replace it with something else. But actually doing that is proving to be a pretty significant challenge for the Republican Party.

JOHN DANKOSKY: And we’ll talk about the challenge in just a moment but I wanted to talk about something the president did that was, I guess, a bit unprecedented. He published a defense of Obamacare in The New England Journal of Medicine. You know this isn’t just a normal place that the President of United States would do something like this. What exactly did he say and why did he do it?

SARAH KLIFF: Yes, President Obama has been building up quite a CV over the past year or so. He actually published in JAMA this summer. This is his second academic article. He used that article in The New England Journal to basically argue in favor of the healthcare law.

This is published about two weeks before he is leaving office, basically to make the case that the healthcare law is working and it is incredibly irresponsible to repeal this healthcare law that’s covering 20 million people if you don’t have a replacement plan. That’s kind of the thrust of his New England Journal article. It’s one last chance to defend the healthcare law just as Republicans are beginning the process of dismantling it.

JOHN DANKOSKY: But he could do this in an Op Ed in The New York Times. He doesn’t have to publish it in a journal. Why do you think he did it that way?

SARAH KLIFF: I think it gives it a little more gravity probably. It definitely has been interesting to see this summer, like I said, President Obama published an article in the Journal of the American Medical Society, JAMA, another leading medical journal, where he talked about the changes he would make to the healthcare law if you were able to make some tweaks around the edges.

I think publishing in these journals gives a little bit more weight. It’s not the only place he talks about this. The same day that he published that New England Journal article he also did an interview with myself and Ezra Klein of Vox, also about the healthcare law. So he’s using a lot of platforms, but I think he sees these respected medical journals as another way to give some kind of weight to his message.

JOHN DANKOSKY: Well, what did you get from him when you sat down and talked with him about the healthcare law? What was the sense you got about how he is taking the fact that what he calls his signature accomplishment is about to be torn down by Congress?

SARAH KLIFF: I think there’s a lot of obvious frustration from President Obama. I think he sees specific problems with the healthcare law, which he talked to us about. One, for example, is affordability. Right now there’s a lot of complaints about the deductibles and the premiums, and he says those are real. He would like to pass legislation fixing those.

So he sees the problems but he also thinks it’s generally a law that’s working, that 20 million people have gained coverage, the uninsured rate in the United States is at an all-time low. I think it is quite frustrating to him that he feels like this law is working, that you could make it better with a few changes here and there, but instead the conversation in DC is really focusing not around changes, it’s focusing around getting rid of the law altogether.

JOHN DANKOSKY: So there’s getting rid of the law and then there is what you replace the law with. A lot of members of Congress going in were talking about repealing Obamacare without a replacement in place. President-elect Trump just this week said, we’re going to have something concurrent, because more and more Republicans are saying we really have to. What can you tell us about that, about the problems of repealing Obamacare now without having a replacement in place?

SARAH KLIFF: Yeah, so there was this strategy that was circulating around Capitol Hill about a month or so ago, really up till this past week, called “Repeal and Delay.” The idea was Republicans, they were kind of as surprised as we were that they’re all of a sudden in control of Congress and the White House. They don’t really have their Obamacare replacement ready. So what they would do is they would repeal the healthcare law, but have that law not take effect for two or three years, thinking like in two or three years we’ll come up with the replacement.

There are a lot of reasons to think this is a very bad plan. A lot of conservative healthcare experts that I know came out in opposition to this plan, because they think it’s incredibly disruptive to say that the healthcare law’s marketplaces are just going to end in two years. They think all the insurance companies will just leave because why would you stay in a market that is closing?

So now you’ve seen the approach, really, because of a lot of pushing from President-elect Trump, move toward repeal and replace at the same time. The problem is that’s really challenging because Republicans don’t really have a replacement plan they’ve all coalesced around yet. They definitely do have a lot of white papers. They have a few bills in legislative language.

But these are ones that are being picked up off the shelf. They’re ones that have gathered a few inches of dust over the past few years as they’ve had a Democratic president who is going to veto them. It’s going to be very hard to deliver on Donald Trump’s request that this happen within a few weeks.

If you remember the healthcare law, the debate around the Affordable Care Act, that took 15 months just to draft the healthcare law and get that passed. Getting a replacement passed in a few weeks seems really, really implausible to me at this point.

JOHN DANKOSKY: And very quickly, Sarah, do you think that there’s anything left of the Obamacare we know now after it is replaced– if indeed it is? A lot of Republicans say that whole thing about preexisting conditions, we want to make sure that’s still there. But the people who put together the law think that that’s not going to be able to exist without the other components of it. Are there some parts of Obamacare that stick around?

SARAH KLIFF: There are some small parts that near certainly stick around– kids being able to enroll in their parents’ insurance up till aged 26. That will likely stay because it’s incredibly popular. Like you mentioned, the preexisting condition part Republicans say they want to keep it. But in order to do that, you also have to have some unpopular policies like the individual mandate that gets everyone into the system, that gets those healthy people who don’t have preexisting conditions to buy coverage even if they might not feel like they need it.

I think we will see a decent number of the people who have coverage under the ACA will have access to some kind of coverage under the Republican replacement plan. I think one of the things that’s important to keep in mind is it seems to me is that debate is shaping up now that Obamacare really kind of moved the baseline. It insured 20 million people, and any Republican plan it’s going to be compared against that 20 million. It’s not going to be compared against where we were in 2010 before the Affordable Care Act.

And so Republicans, what you see them doing right now is seeing kind of how close can they get to the coverage gains of the healthcare law. My expectation is some of those coverage gains but certainly not all of them will survive in a Republican replacement plan.

JOHN DANKOSKY: Sarah Kliff is senior editor for Vox Media, and she joined us today via Skype. Thanks so much, Sarah.

SARAH KLIFF: Yeah, thanks for having me.

JOHN DANKOSKY: Now President Obama has always been a cheerleader for science. In his first inaugural address, he promised to, quote, “Restore science to its rightful place.” He championed the Office of Science and Technology Policy. He was bullish on STEM education, data science, and funding for scientific research. But did his high opinion of science translate into policy decisions that really made an impact?

We’re going to take a look at the science legacy with my next guests. Julie Palakovich-Carr is public policy manager for the American Institute of Biological Sciences. Julie, welcome to Science Friday.

JULIE PALAKOVICH-CARR: It’s a pleasure to be with you.

JOHN DANKOSKY: Angela Anderson is director of the climate and energy program for the Union of Concerned Scientists. Angela, welcome.

ANGELA ANDERSON: Thank you. Good to be here.

JOHN DANKOSKY: And we should note that the Union of Concerned Scientists is an occasional funder of Science Friday. Angela, I’ll start with you. And we were just talking about President Obama published an article in The New England Journal of Medicine this week. He also wrote in the journal Science about his energy legacy. What did he say there?

ANGELA ANDERSON: That was an amazing piece. The president really wrote about the unstoppable momentum that has been launched around clean energy and really documenting how the marketplace, particularly with the recent abundance of natural gas, has really changed the economics of the energy industry.

That development, combined with the falling prices of solar and wind, really has those two sources of energy kind of at parity. And he made the case that this sort of regardless of what happens with his signature climate plan, the Clean Power Plan, that we will continue a drive towards a decarbonized energy system.

JOHN DANKOSKY: But do you agree with this argument basically that the clock’s not turning back? President-elect Trump talks about more fossil fuels, more people mining coal and burning coal in America. Does that signal bad things for Barack Obama’s argument here?

ANGELA ANDERSON: I’ve read a lot on both sides, and I actually think that there’s more evidence on of continued progress towards renewable energy. Certainly it’s going to be much harder than President-elect Trump thinks to move away from the policies that encourage clean energy, because they’re very bipartisan in nature these days. Places like Iowa and Kansas and just driving across the country you can really see how much clean energy is taking hold and it is creating jobs. And so you don’t want to take those jobs away.

So I think that there is probably more evidence on the side of progress. I think we have to be quite diligent at the state and local level to really do everything we can to make sure that at that level there is a continued commitment and expanded commitment to more renewable sources of energy.

JOHN DANKOSKY: So Julie, from your perspective, what do you consider some of the marquee moments of the Obama administration when it comes to science?

JULIE PALAKOVICH-CARR: Well. I think President Obama really set the stage for his administration when he was sworn in 2009 and, as you mentioned before, pledged to restore science to its rightful place. His administration really has made a good faith effort to achieve that goal. The president personally has been very visible on science and engineering issues.

Everything from hosting six science fairs at the White House to try to encourage young people to be interested in science and engineering to discussing science as part of every one of his State of the Union addresses. That certainly was a departure from his two immediate predecessors.

He leaves a legacy, certainly, in terms of a number of major initiatives. Everything from the brain initiative on neuroscience to precision medicine and most recently the cancer moonshot. We’ve seen bipartisan support, particularly in terms of funding for those initiatives, from members of Congress. So I think there’s a good chance that some of those programs will go on.

JOHN DANKOSKY: Can you talk a bit more about that goal, though? When he says “restore science to its rightful place,” what do you think he means by that? And what’s the rightful place of science that was missing?

JULIE PALAKOVICH-CARR: Well, certainly to have science as part of the decision-making process within the federal government. A big part of his initiative on scientific integrity and the executive order he issued very early in his administration resulted in federal agencies issuing their own plans and policies on science integrity, which in many cases lifted the gag order on federal researchers so that they could actually talk about their research results with the media and members of the public without having to get internal approval beforehand. So that really made a difference for scientists who were working on issues that were previously deemed politically controversial, things like climate change.

JOHN DANKOSKY: I’m John Dankosky, and this is Science Friday from PRI, Public Radio International. And we’re talking with Julie Palakovich-Carr and Julia Anderson about the Obama legacy in science. If you have a thought, 844-724-8255. That’s 844-SCI-TALK. I wanted to hear from you, Angela, about that, about some of the marquee moments you think of the Obama administration and science the last few years.

ANGELA ANDERSON: Sure. I did want to make a comment on the scientific Integrity piece. I agree with everything Julie said, and I wanted to let you know that next week we’re actually going to be doing a review of those 23 federal agency policies on scientific integrity to remind the incoming secretaries that their agencies do have these policies and hold them accountable for maintaining or even improving them. So we’ll be spotlighting that next week.

What I think about what you call marquee moments, the one that really stands out obviously and is close to my heart was when the president did really the first-ever hour-long speech on climate change. And he did it standing at Georgetown University on a sweltering hot July summer day, and essentially delivered a speech that rivaled anything Al Gore could have done with his slides.

And then he backed that up with a series of policies and a directive to all the agencies to look for ways to take the reality of climate change into account in everything that they did. And that’s our best hope, actually, for forward progress is to continue to connect people with the reality of climate change and get very practical about it.

JOHN DANKOSKY: But I do have to ask, and a lot of his critics say that because he spent so much time and political capital passing the Affordable Care Act that his zeal for climate change really came a little too late in the game. Is there something to that, Angela?

ANGELA ANDERSON: Well, surrounded by the scientists that I work with, any delay is really sad, and we did lose a lot of time and effort. I place the blame partly with the president, of course, but mostly because he was still holding out hope that he could work with Congress on this issue. And he was giving them a shot at doing what everyone thought was better at the time, which was to try to do this legislatively rather than through an agency rulemaking.

And it was really when he had given up hope on that that what he decided to do in terms of going it alone with agency work, he really kind of let loose and then went beyond what I think anyone expected.

JOHN DANKOSKY: Julie, do you have a thought on that? Because again a lot of people say especially in your world any delay on something as important as climate change does really set us back. Do you think that the president was aggressive enough?

JULIE PALAKOVICH-CARR: Well, this is probably one of those issues where the president could have spent more of his own political capital and I’ll pivot a moment actually to another one which was long-term budget reform. You may I ask, what does that have to do with science? But in terms of science funding, budget sequestration and the Budget Control Act that implemented that law really has been extremely detrimental to research funding here in the US.

At this point, researchers are really struggling to actually get grants funded. When your chance of getting a grant funded is less than 20% for most agencies at this point, it’s pretty troubling.

JOHN DANKOSKY: How about your grade, Angela, on promoting renewable energy resources? Do you think that he has done enough over his tenure?

ANGELA ANDERSON: Yeah I think that’s a mixed bag on that one as well. Again, in the first term there was what was seen as the Solyndra scandal. And then they were also really promoting a clean energy standard, again an attempt to really foster bipartisan support by lumping together low carbon fuels, including nuclear and natural gas, to advance energy policy.

And so I think at the end of the day, though, especially after the Paris agreement was signed, he really did lean in working with Congress to get a five-year extension on the wind and solar tax credits, and that’s going to make a very big difference.

JOHN DANKOSKY: Angela Anderson, director of climate energy program for the Union of Concerned Scientists. Julie Palakovich-Carr, public policy manager for the American Institute of Biological Sciences thank you both so much for your time. I appreciate it.

Copyright © 2016 Science Friday Initiative. All rights reserved. Science Friday transcripts are produced on a tight deadline by 3Play Media. Fidelity to the original aired/published audio or video file might vary, and text might be updated or amended in the future. For the authoritative record of ScienceFriday’s programming, please visit the original aired/published recording. For terms of use and more information, visit our policies pages at http://www.sciencefriday.com/about/policies/