United States

Patient Protection and Affordable Care Act (Obamacare)

In March 2010, having secured the support of a sufficient number of House Democrats who had been opposed to aspects of the Senate plan (most notably pro-life advocates led by Rep. Bart Stupak, whose fears that the plan would loosen limits on abortion funding were allayed by Obama’s promise of an executive order), Pelosi engineered passage of the Senate bill in a 219–212 vote (with all Republicans and 34 Democrats in opposition) on Sunday night March 21. A subsequent bill, proposing “fixes” to the Senate bill, was then passed and sent to the Senate, where Democrats hoped to obtain passage through the use of a relatively seldom-used procedure known as reconciliation, which requires a simple majority for passage. With the outcome of reconciliation still in the balance, on March 23 Obama signed into law the historic legislation, the Patient Protection and Affordable Care Act. Senate passage of the bill of proposed fixes proved arduous, as Republicans introduced more than 40 amendments in an attempt to force another vote in the House. All those amendments were defeated in votes along party lines, and on March 25 the bill was passed by a 56–43 vote; however, because of procedural violations in some of its language, the bill went back to the House. There it passed by a 220–207 vote. No Republicans in either house voted for the bill.

In its final form, the Patient Protection and Affordable Care Act would—once all its elements had taken effect over the next nine years—extend health care to some 32 million previously uninsured Americans and prohibit insurers from denying coverage to those with preexisting conditions. The bill, which required that all citizens obtain health care insurance, also provided subsidies for premium payments for families earning less than $88,000 per year, with the funding to come largely from a tax increase for the wealthiest Americans. It also promised a tax credit to small businesses that provide coverage for their employees.