That replacement didn't last long. The Democrats had an absolutely historic filibuster-proof majority. It's a bit odd that blue Massachusetts would choose a Republican, even a relatively moderate one, to replace Kennedy, but for the Senate as a whole it was something of a reversion to the mean. He did not win re-election, and was replaced by Elizabeth Warren.
It did derail the Democratic agenda, but mostly because Republicans made it their mission to ensure that Obama was a one term President. That has been policy ever since, and effectively zero legislation has come out of Congress since.
Democrats did manage to finesse the sole legislative accomplishment of the last couple of decades, the Affordable Care Act. In a lot of ways it was a fairly trivial change to the health care system, but getting anything passed at all was, in the Vice President's words, "a big [effing] deal".
> It's a bit odd that blue Massachusetts would choose a Republican, even a relatively moderate one, to replace Kennedy
It feels that way, but let's remember that Republicans have held the governorship in Massachusetts for most of the past 30+ years. That's an interesting broader phenomenon, though. A number of other states have turned reliably blue in congressional and presidential elections while voting in Republican governors. New Hampshire is like that, and I was recently surprised to learn that Vermont is too.
And Maryland, where I'm from. Our most recent Republican governor ran for Senate, in the awkward position of trying to run away from Trump. It did not work.
Those Republican governors in blue states try to run as "old fashioned" conservatives, more about economic policy than culture war. It can work within the state but less well when the national platform is at stake.
I actually think the Green New Deal (aka Inflation Reduction Act), CHIPS Act, and the extra $500B in infrastructure spending totalled together probably overtake the strategic importance of something like the ACA. But to each their own, most people disagree with that view.
The ACA was a huge change. People generally know about the parts about mandates et al.
The provisions for moving beyond paper was one of the biggest, and most relevant to people here. Examples are the use of electronic records, the incentives to actually use them (both for patents and for metrics), etc.
Due to the market power of Medicare, it also changed payments from per procedure to per outcome.
Many of these changes were quite deep. I would not use trivial to describe it.
I say "trivial" in that it did not actually change the core elements of private insurance and employer sponsorship. It's a slightly improved version of the old system -- one which recently provoked literal blood lust from both sides of the aisle.
Within that framework the changes can be seen as significant. But that framework is widely despised in the US and considered insane everywhere else.
It did derail the Democratic agenda, but mostly because Republicans made it their mission to ensure that Obama was a one term President. That has been policy ever since, and effectively zero legislation has come out of Congress since.
Democrats did manage to finesse the sole legislative accomplishment of the last couple of decades, the Affordable Care Act. In a lot of ways it was a fairly trivial change to the health care system, but getting anything passed at all was, in the Vice President's words, "a big [effing] deal".