The History of the Affordable Care Act

The Battle for U.S. Health Care Reform

History had by now set the battle lines for the political debate over health care. The old arguments would play out repeatedly in the year following President Obama's February 2009 address urging a joint session of Congress to pass affordable universal health care. The philosophical divide made itself most clearly known during the debate over the public option, which would have created a new government-run insurance program similar to Medicare.

This was the approach favored by liberal Democrats, who argued that true health care reform depended on such a system [source: Stolberg]. But it threatened to alienate moderate Democrats -- a party division that supporters could ill afford, in light of Republicans' staunch resistance to Obama's health care reform plans and to the public option. Republicans argued that such a system would kill competition, drive private insurers out of business and push consumers into the government program. Obama meanwhile downplayed the public option's importance, possibly viewing it as a bone he might throw to Republicans if needed [sources: Pear and Calmes; Stolberg].

By September 2009, the public option was on life support and fading fast. Democrats knew they needed to jettison it if they were to hold on to any hope of the 60 votes needed to overcome a Republican filibuster [source: Pear and Calmes]. A deal struck in early December nearly saved it, but when Sen. Joseph Lieberman, independent of Connecticut, threatened to vote against the compromise all momentum was lost[source: Herszenhorn and Kirkpatrick]. After losing the supermajority in January 2010, the Democrats finally abandoned the public option.

The essence of the administration's health care reform plan, which included creating a system that forced insurers to compete in the marketplace and exchanges that enabled consumers to find affordable plans, survived. By February 2010, the Obama administration was pushing a revised plan with better chances, and House Minority Leader Nancy Pelosi was gathering votes to support it. On March 21, 2010, House Democrats passed the Senate bill against unanimous Republican opposition [source: Goodridge and Arnquist].

On March 23, President Obama signed the Patient Protection and Affordable Care Act of 2010 into law. Two days later, the budget reconciliation measure containing the final ACA changes was approved by Congress, again over united Republican opposition [source: Herszenhorn and Pear].