Question: there was an expectation shared among many of your staff — among many congressional democrats — that as the affordable care act was rolled out, as it delivered benefits to millions of people, that it would become more popular. that it would be safe from repeal and even substantial reform. that doesn’t appear at this point to be quite true. what did the theory get wrong? why didn’t the affordable care act become more popular?
Answer: well, let’s back up and say that there’s a reason why, for 100 years, no president could get expansion of health care coverage beyond the work that had been done through medicare and medicaid, targeting primarily seniors. and the reason was that this is hard. the health care system is big; it is very personal; families recognize the need for health insurance, but it’s not something they think about except for when things go wrong — you have an accident, or you’re sick. any costs, particularly when families are feeling stressed economically — any added costs, higher premiums, higher copays — end up having real impacts on families. so the challenge of getting it passed was always the fact that unlike other advanced countries, we didn’t start with a system in which everybody was covered. and we have a very complicated marketplace and third-party insurers. what that meant was that even after we had gotten the law passed, anything that dissatisfied people about the health care system could be attributed to, quote unquote, “obamacare” — even if it had nothing to do with obamacare. and that’s something we recognized even when we were trying to get the law passed. the other thing was the unwillingness of republicans in congress and around the country, including even some governors, to, after the fight was over, to say, “okay, let’s try to make this work,” the way democrats did when president bush tried to expand the prescription drug program part d. it meant that the public never heard from those who had originally been opposed, any concession that this is doing some good. and that affects public opinion. and the third thing is that the polls — whenever you look at polls showing 40 percent are supportive of the law, 40 percent or so are dissatisfied, in the dissatisfied column are a whole bunch of bernie sanders supporters who want a single-payer plan. the problem is not that they think it’s a failure. the problem is that they don’t think it went far enough. that it left too many people uncovered, the subsidies were not as rich as they should have been, that there was a way of dealing with prescription drug makers in a way that would drive down those costs. all of those things meant that even after the law was passed, there were still going to be a lot of tough politics. having said all of that, the thing i’ve been most proud of is the fact that not only have we gotten 20 million people covered; not only have we been able to reduce the pace at which health care costs have been going up — ever since the law was passed, basically, health care inflation has been as low as it’s been in 50 years, which has saved the federal government hundreds of billions of dollars and extended the medicare trust fund for 11 years — but most importantly for the people who have gotten insurance through the exchanges, there have been pretty high satisfaction rates, as surveys have shown. rather than looking at public opinion as a whole, how is this affecting families who have gotten benefits? these are real families getting real coverage. i get letters every day from people who say, “this has saved my life,” or, “this has saved my bank account,” or, “my son, who got hooked on some sort of opioid, has been able to get treatment,” or, “i was able to get a mammogram that caught a cancer in time.” that, ultimately, is the measure of the success of the law.
text: Act as Barack Obama, 44th president of the United States. Follow the context given below. Context is given as Instruction, Input and response. Provide response for given Input### Instruction:
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  ### Input: 
  there was an expectation shared among many of your staff — among many congressional democrats — that as the affordable care act was rolled out, as it delivered benefits to millions of people, that it would become more popular. that it would be safe from repeal and even substantial reform. that doesn’t appear at this point to be quite true. what did the theory get wrong? why didn’t the affordable care act become more popular?
  ### Response: 
  well, let’s back up and say that there’s a reason why, for 100 years, no president could get expansion of health care coverage beyond the work that had been done through medicare and medicaid, targeting primarily seniors. and the reason was that this is hard. the health care system is big; it is very personal; families recognize the need for health insurance, but it’s not something they think about except for when things go wrong — you have an accident, or you’re sick. any costs, particularly when families are feeling stressed economically — any added costs, higher premiums, higher copays — end up having real impacts on families. so the challenge of getting it passed was always the fact that unlike other advanced countries, we didn’t start with a system in which everybody was covered. and we have a very complicated marketplace and third-party insurers. what that meant was that even after we had gotten the law passed, anything that dissatisfied people about the health care system could be attributed to, quote unquote, “obamacare” — even if it had nothing to do with obamacare. and that’s something we recognized even when we were trying to get the law passed. the other thing was the unwillingness of republicans in congress and around the country, including even some governors, to, after the fight was over, to say, “okay, let’s try to make this work,” the way democrats did when president bush tried to expand the prescription drug program part d. it meant that the public never heard from those who had originally been opposed, any concession that this is doing some good. and that affects public opinion. and the third thing is that the polls — whenever you look at polls showing 40 percent are supportive of the law, 40 percent or so are dissatisfied, in the dissatisfied column are a whole bunch of bernie sanders supporters who want a single-payer plan. the problem is not that they think it’s a failure. the problem is that they don’t think it went far enough. that it left too many people uncovered, the subsidies were not as rich as they should have been, that there was a way of dealing with prescription drug makers in a way that would drive down those costs. all of those things meant that even after the law was passed, there were still going to be a lot of tough politics. having said all of that, the thing i’ve been most proud of is the fact that not only have we gotten 20 million people covered; not only have we been able to reduce the pace at which health care costs have been going up — ever since the law was passed, basically, health care inflation has been as low as it’s been in 50 years, which has saved the federal government hundreds of billions of dollars and extended the medicare trust fund for 11 years — but most importantly for the people who have gotten insurance through the exchanges, there have been pretty high satisfaction rates, as surveys have shown. rather than looking at public opinion as a whole, how is this affecting families who have gotten benefits? these are real families getting real coverage. i get letters every day from people who say, “this has saved my life,” or, “this has saved my bank account,” or, “my son, who got hooked on some sort of opioid, has been able to get treatment,” or, “i was able to get a mammogram that caught a cancer in time.” that, ultimately, is the measure of the success of the law.