How Obamacare Became Law

I originally posted this piece on November 21, 2013.  However after yesterday’s Supreme Court ruling it began trending, so I’m reposting:

It was the trickiest legislative move ever accomplished in the Congress.  Here’s my best play-by-play:

Obamacare was signed into law in March 2010.  If you recall, Nancy Pelosi’s Democratic majority in the House of Representatives was unable to pass their version of a healthcare law. Because all revenue bills have to originate in the House, the Senate found a bill that met those qualifications: HR3590, a military housing bill. They essentially stripped the bill of its original language and turned it into the Patient Protection and Affordable Care Act (PPACA), aka Obamacare.

The Senate at that time had 60 Democrats, just enough to pass Obamacare.  However after the bill passed the Senate, Democrat Senator Ted Kennedy died.  In his place, Massachusetts elected Republican Scott Brown.  That meant that if the House made any changes to the bill the Senate wouldn’t have the necessary number of votes to pass the amended bill (because they knew no Republicans would vote for Obamacare).  So Senate Leader Harry Reid cut a deal with Pelosi: the House would pass the Senate bill without any changes if the Senate agreed to pass a separate bill by the House that made changes to the Senate version of Obamacare.  This second bill was called the Reconciliation Act of 2010. So the House passed PPACA, the Senate bill, as well as their Reconciliation Act. At this point PPACA was ready for the President to sign, but the Senate still needed to pass the Reconciliation Act from the House.


We all were.

And it got worse.

Remember that the Senate only had 59 votes to pass the Reconciliation Act since Republican Scott Brown replaced Democrat Ted Kennedy.  Therefore in order to pass the Act Senate Democrats decided to change the rules.  They declared that they could use the “Reconciliation Rule (this is a different “reconciliation” than the House bill).  This rule was only supposed to be used for budget item approvals so that such items could be passed with only 51 votes in the Senate, not the usual 60.  Reconciliation was never intended to be used for legislation of the magnitude of Obamacare. But that didn’t stop them.

So both of the “Acts” were able to pass both houses of Congress and sent to President Obama for his signature without a single Republican vote in favor of the legislation.  The American system of governance was shafted.  To quote Democrat Rep. Alcee Hastings of the House Rules Committee during the bill process: “We’re making up the rules as we go along.”



  1. Thanks for finally writing about >How Obamacare Became Law — Brian Sussman <Liked it!

  2. empty pockets says:

    “making up the rules as we go along”…indeed. And then they don’t even follow their OWN rules. The lawlessness and corruption would make any banana “republic’ dictator so proud. I wonder if Chavez is applauding…from hell.

  3. why doesn’t the Senate use this rule to get a vote on the Iran Bill????

  4. SO WHAT if both bills were passed without a single Republican vote? “The American system of governance” does not require bipartisan support to pass a bill into law, it just requires a majority vote of the House and Senate.

  5. Two points:

    1) Ted Kennedy died on August 25, 2009 – almost exactly four months to the day before the Senate passed the PPACA. Even Democrats have not yet managed to get help in a key Senate vote from a dead man.

    2) Sussman does even attempt to explain how the HCERA fails to satisfy the constraints on reconciliation bills. It shouldn’t be difficult – the rules aren’t complicated.

    Budget reconciliation cannnot be used if a bill
    1. does not produce a change in outlays or revenues;
    2. produces an outlay increase or revenue decrease when the instructed committee is not in compliance with its instructions;
    3. is outside the jurisdiction of the committee that submitted the title or provision for inclusion in the reconciliation measure;
    4. produces a change in outlays or revenues which is merely incidental to the non-budgetary components of the provision;
    5. would increase the deficit for a fiscal year beyond those covered by the reconciliation measure; and
    6. would make changes in Social Security.

    Here is the text of the HCERA:

    Why was it not eligible for passage by budget reconciliation?

  6. It was passed through an unprecedented use of the budget reconciliation process. If the Republicans tried something like this the Democrats and media would still be screaming bloody murder.

  7. Greg Magnus says:

    A couple questions I have never heard asked:

    1. The Supreme Court, Roberts, declared that the penalty for not being insured is in fact a tax and Congress has the authority to impose taxes. Congress did not pass a tax. Congress specifically passed a penalty and would not pass a tax in this situation. Where is the Congress’ institution of this so-called tax? The Supreme Court can’t institute a tax.

    2. The ACA provided for subsidies for enrollees specifically through the individual state marketplaces. That was supposed to be incentive for the states to establish healthcare marketplaces for their citizens.
    Most states did not establish their own marketplaces and others tried but failed. The Supreme Court ruled that the subsidies are to be given to people who signed up for ACA through the Federal Exchange in contradiction to Congress’ intent.
    If the subsidies are available through the federal exchange are not the state exchanges redundant? Why are there state exchanges after the Supreme Court’s decision. Why are any states running exchanges at great expense?

    I do hope you can answer these questions.

  8. Linda Clark says:

    Explain the rest, please, after the Senate did what you explained…what happened with the Supreme Courts involvement. Why did Justice Roberts one vote go the way it did…and how in the heck did this AFA get deemed constitutional because Roberts called it a tax.

    Confused still.

  9. This is exactly why Trump is where he is. We the people are fed up with all the political conniving BS!

  10. Ben broughton says:

    Did the gop add any amendments to the bill that passed?

  11. Passing a law of this magnitude without a single Republican vote sure seems wrong. They bypass the system or tweak it until it works for their needs. They redefine Democracy. We live in sad times.

  12. Larry crosby says:

    The bill has saved some lives it saved my sister n laws life.some things require a bi partisan solution to make things better for the american people. We must find a way to elect the right people for these jobs.

  13. Larry crosby says:

    We must have a congress that works for the american people.


  15. How is the Rep, House and Senate going to REPEAL completely obama care with President Trump? im geting a little on edge after reading several post saying they dont have the votes to do a FULL repeal. any commits, thoughts?

  16. I have some questions :
    Why was there such opposition to the Clinton health care proposal when it was clear even back then that there were major problems with our health care system?
    Why was there no attempt during the George W Bush tenure, to address the health care problem?
    Why was there no attempt to amend, or repair, the ACA by Republicans during the Obama presidency?

  17. Louis gross says:

    How can anybody put a monetary price on a human life.

  18. Michael Bane says:

    The Affordable Care Act is meant to help the american people and that is what it has done. Our private sector systems have failed us and that is why the government is even stepping in to help. We should be voting for candidates on issues and not on party lines. There are plenty of corrupt or questionable democrats and republicans.

    Donald Trump bragged about being smart in taking advantage of tax loopholes, but when democrats take advantage of loopholes to pass the Affordable Care Act, they are a disgrace? You should look at Trump, his history of failed business and taking advantage of loopholes (and his inherited fortune) to keep himself afloat. He is not in power for the american people, it is for himself and his friends. He took advantage of the desperate needs of our prideful american workers that want jobs, better pay, and our government back from the elite. He fooled half of this country to get him into power, took advantage of another “loophole”.

    He preached draining the swamp and even prosecuting Hillary, but backs down once in office. He then starts appointing CEO’s of the companies that these lobbyist, we were promised to have removed, work for. Now these companies will have direct access to make profit off of our american tax dollars. Prepare yourselves for 4-8 years of a decline in our nation.

  19. Linda Stanton says:

    This is the most accurate account of ACA I have seen. There are actual 5 bills & I have read 4.. Sarah Palin 1….Nancy Pelosi, Harry Reid, & Obama -0-NONE! In their haste to pass the Senate written bill they passed the wrong one…. that is why they passed out vouchers the first year.

    John Roberts deemed the bill a tax… as that is how the bill started. It was a passed bill 100% bi-partisainly to adjust the tax bill’s for home bound Veterns. Democrat Berne Frankel left the 1st line of the passed tax bill —THEN GUTTED IN its entirely the tax bill….THEN INSERTED Obamacare…. many Senators & Congress people of both parties tucking in costly tidbits before passing the SENATE written bill!! But Republican’s -0- voted on it! Nor did they encourage any of their Democrat friends to say No…. lots of arm twisting & Pay offs for a yes vote…. Go Tom Price!

  20. No response on my last post. We need to REPEAL obamacare, that’s why Republicans where elected. We have a willing President now, BUT! Where is OUR CONGRESS??? The Dems shoved obamacare down OUR throats! The House and Senate need to act NOW. I gave A LOT of money to the Republicans to act! REPEAL it through reconciliation, just like they passed it!!!!! THOUGHTS??

  21. The patient protection and affordable care act (PPACA), is based on the plan republicans John Chafee, Chuck Grassley, Orrin Hatch and others crafted in 1993 as an alternative to Clinton care. The individual mandate and exchanges with private insurers were hallmarks of that plan which also became the model for Romney care in Massachusetts. Early on, the framers of the PPACA were a bipartisan group called the gang of six, which included 3 republicans (Grassley, Mike Enzi and Olivia Snow) and 3 democrats (Max Baucus, Jeff Bingaman and Kent Conrad). But republican leader Mitch McConnell, out of fear that a bipartisan plan would look good to the public at large (and make Obama and democrats look good too), put together a strategy to polarize the congress to win back the House in the mid-term (which was a successful strategy). As a result, the republicans in the gang of six, while continuing to have input into the legislation, ultimately withdrew their support under pressure from their party. In looking back, it seems likely that PPACA would never have been voted in if not for this polarization strategy because when Enzi and Grassley started trashing the bill as if they weren’t ever involved with it, democrats further to the left (i.e., Bernie Sanders) and more conservative democrats, who may have never voted for the bill, decided to align with their party in reaction to the McConnell strategy. That’s what gave the PPACA its purely partisan split, not necessarily that republicans, especially those who worked on it, disliked it. So, in exchange for future gains for the party, it’s possible for one to say that it was Mitch McConnell that paved the way for PPACA through congress. I don’t clearly understand the procedural aspects that occurred after that in regard reconciliation, but it should be no surprise–because we are seeing it currently with the flurry of executive orders–that politicians will take whatever path is available to get their way. It is my understanding, however, that the result was legislation that could not be easily modified because it did not contain modification provisions that other major legislation would normally have had. Considering what’s happening currently, it’s interesting to see the denouncing of the individual mandate (which is probably necessary to help keep premiums down) as well as bemoaning the market place issues (clearly broken and in need of fixing), which derive from the heart of conservatism. It’s also surprising to see the difficulty with which our current leaders are having in repealing and replacing PPACA. But not too surprising, given the template upon which it was created.

  22. Whether Republican or Democrat, the ACA IE; obamacare, is a damning bill on ALL Americans. If you deny this fact, then you are being partisan. The Government ALWAYS puts a cost on people’s lives. Go look it up THATS WHY “THEY ARE ENDOWED BY THEIR CREATOR” not the GOVERNMENT. Human life deserves respect because we only get one chance, and there will never be another one of “you.” by the very fact WE THE PEOPLE are still arguing over this bill shows us all that it IS A MESS. REMOVE, REPEAL, and fix the issues that needed to be FIXED. PREEXISTING, CONDITIONS. DO NOT give more TAXING power to the al GROWING Government. When has anyone seen there water bills go down? Even when in places we see a massive increase in rain? Drought gone, not to the Government. They ignore that fact. PLEASE GIVE BACK the power the to the place it was meant to be, WE THE PEOPLE.

  23. Please post on FB. Best article I have ever read on the issue.

  24. Talk about not telling the whole story. Good lord, if you’re going to post it, tell the entire story.

    The U.S. House of Representatives was safely Democratic as a result of the Nov. 4, 2008, elections by a margin of 257 – 199; the Democrats had gained 21 seats from the 2006-07 Congress. The real interesting ACA political dynamics began during the November 2008 U.S. Senate elections.

    Going into the 2008 elections, the Senate consisted of 49 Democrats, 49 Republicans, and two Independents (Joe Lieberman of Connecticut and Bernie Sanders of Vermont) who caucused with the Democrats. When the smoke cleared from those elections, the Democrats picked up eight seats to increase their majority to 57-41 (although Democrat Al Franken’s recount victory was not official until July 7). With the two Independents, the Democrats were one vote shy of the supermajority magic number of 60 they needed to ward off any filibuster attempts and move forward with broad healthcare reform legislation.

    But on April 28, 2009, the dynamics changed when Pennsylvania Republican Arlen Spector changed parties, giving Senate Democrats that coveted 60th vote.

    Now the Democrats had a safe majority in the House and a filibuster-proof supermajority of 60 in the Senate. That scenario lasted only four months before fate intervened. Sen. Ted Kennedy of Massachusetts died on August 25, 2009, leaving the Democrats, once again, with 59 seats (counting the two Independents). Exactly one month later, on September 25, Democrat Paul Kirk was appointed interim senator from Massachusetts to serve until the special election set for January 19, 2010 – once again giving the Democrats that 60th vote. But the intrigue was just beginning.

    With the super majority vote safely intact once again, the Senate moved rather quickly to pass the ACA – or ObamaCare – on Christmas Eve 2009 in a 60 – 39 vote (Kentucky Republican Senator Jim Bunning chose not to vote since he was not running for reelection). The House had previously passed a similar, although not identical bill on November 7, 2009, on a 220 – 215 vote. One Republican voted “aye,” and 39 Democrats were against.

    There didn’t seem to be an urgent need for Democrats to reconcile both bills immediately, because the Massachusetts special election (scheduled for January 19, 2010) was almost certain to fall to the Democrat, Attorney General Martha Coakley. After all, no Republican had been elected to the U.S. Senate from the Bay State since Edward Brooke in 1972 – 38 years before! But in yet another twist of fate, Republican Scott Brown ran his campaign as the 41st senator against ObamaCare and shocked nearly everyone by winning the special election by 110,000 votes.

    That left House Speaker Nancy Pelosi and President Obama in a dilemma. Everyone assumed that the Christmas Eve 2009 Senate bill would be tweaked considerably to conform more with the House bill passed two months previously. But now that strategy wouldn’t work, because the Democrats no longer had the 60th vote in the Senate to end debate. What to do? They decided to have the House take up the identical bill that the Senate passed on Christmas Eve. It passed on March 21, 2010, by a 219 – 212 vote. This time, no Republicans came on board, and 34 Democrats voted against. President Obama signed the ACA legislation two days later on March 23.

    The rancor has not abated since, as we all know. Republicans invoked Thomas Jefferson’s observation that “great innovations should not be forced on a slender majority – or enacted without broad support.” They cited broad legislative innovations like Social Security and Medicare, both of which enjoyed bipartisan support. They complained that one fewer vote in the Senate or a change of four votes in the House would have been enough to defeat ObamaCare. Democrats responded just as vociferously and passionately that this healthcare reform package was too important and overdue to delay or compromise.

  25. Linda Landsverk says:

    What are people supposed to do when they have no health insurance? I for one have pre-existing conditions and could never qualify for private insurance. Why can’t they just work together to fix ACA?

  26. steve brown says:

    the new health bill that was introduced today if passed will not provide insurance for people with major preexisting conditions like cancer diabetes and major sickness and some kind of age tax for people between the ages of 55 up to 64 yearsold. It was stated today it could cost older people up to 13000 a year who can afford that. Obama care is not the best but the republican party would not work to make it better. This new bill has the tea party approval . When trump was elected he promised everybody would have affordable insurance. Now 8 million uninsurable people will be unable to by insurance period and the older ones want be able to buy it. So now through all the broken promises we are right back in the 1980 no insurance.

  27. Dee Hayes says:

    In our family of two (55 yrs and 59 yrs old) insurance went up to $1151 per month as a result of Obamacare rules. It’s going up again to $1290 in August 2017; that’s more than our mortgage, taxes and interest on our home. We have no major health issues. No diabetes, no cancer, heart problems, etc. These premiums are double what we used to pay before the ACA. Not affordable. And health insurance is not health care. Deductibles have gone higher to the point where most average people are not able to meet the deductible before their insurance will cover care. Choices of plans and insurers are fewer after ACA kicked in. My husband and I have adult children that live on their own in another state, yet our insurance must contain Pediatric Dental coverage. This is just plain ridiculous.

  28. Two areas that I have not seen commented on are first, “the ACA had lots of Republican input and amendments”. But how could it, it was a different bill than was passed by the House during 2009. They (Democrat Party) claim their bill was available to be read well before it was voted on. If so, why did Pelosi need to make the statement that it needed to be passed before we could now what was in it? (I think it was because she knew the “heart” of the bill would be written by government employees who were unaccountable to voters.) The second area of concern is the “afford” part of the ACA. Even after the gov’t pays a large part of a LOT of the policies, a lot (majority?) of people cannot afford to use their insurance, thus cannot afford health care. Extremely high deductibles and total out-of-pocket are the cause. People have reported deductibles in the $5,000 range and out-of-pocket costs over $10,000. Who in a working family can afford that? People who liked their insurance couldn’t keep it because the gov’t forced the insurance companies to drop the policies. People couldn’t always keep the doctors they liked because of the doctors not being available on all policies. And the price of policies going down by $2,500, not even close, they have increased. Drastically! (These 3 are from the promises by Obama) And as to the “tweaking” the ACA, it’s almost impossible because everything is too intertwined. (You might be able to repeal, then add some of the provisions back in) Three factors that are seldom discussed in relation to pricing of policies, increased competition (crossing state lines ?), reducing policy mandates and pulling pre-existing conditions out and have them covered under gov’t subsidies (instead of subsidizing many, many more policies as it does now).

  29. @Michae Bane. Put down the crack pipe. The “unaffordable care act” was nothing more than a tax increase and big Govt expansion. This has helped NO ONE!! It needs to be repealed!! Period!! Insurance companies should have the ability to cross state lines and sell to whoever!! UNBRIDLED COMPETITION is the ONLY way to control quality and costs! The Govt has never and will never be able to wipe their asses efficiently!!

  30. My husband and I are healthy, self employed 58-years olds, and the annual cost of health is mind blowing. Each year we shoot for high deductibles to save money. We each once met our $7,500 deductible – not bragging – (this does not include our $1,000/month premiums). We can hardly afford to live, let alone afford to be ill. Repeal Obamacare.

  31. I agree with Wayne Repeal The O-Care BILL! GOP Sens. Susan Collins (Maine)(207) 622-8414, Lisa Murkowski (Alaska)(907) 271-3735 , and Shelley Moore Capito (West Virginia) (304)-347-5372.said they would vote against REPEAL though they are on record except 1 voting for FULL repeal. President Trump Won West Virginia by a HUGE mandate margin. CALL THEM……

  32. Shelley Clark says:

    The longest lasting democracy in history is under attack. How do we work out a system “of the people” when half the people have vilified those who don’t share the same backgrounds, experiences, and political beliefs as the other half? I wish people could look beyond their own personal politics or experience and see the bigger picture, which is this whole country! If the ACA was a detriment to the majority of Americans, Obama would not have been re-elected. And after 7 years, repeal and replacement would be easy for a party that has planned it for that long. The law is certainly not without its flaws, but it changed my life. As an over 50, single, independent contractor, who had a pre-existing condition when I went solo and no longer had employer-funded insurance, I was amazed at what a mid-range insurance policy cost me in 2006. I had to pay almost 20% of my income on healthcare, which included a policy that provided minimal coverage. Without treatment for my chronic condition, I could not work, so I had no choice. Since the ACA, I bought coverage on the exchange (with many choices), cut my premiums by 60% (thanks to the subsidy), and increased the coverage (as all policies were required to cover prevention services, not just treat illness). I did like my doctor, but could not keep my doctor – as Obama had misstated – because he was not a provider under my plan. However, I found another nearby doctor that I liked just as much and can now benefit from comprehensive services. And yes, my premium doubled this year, BUT it’s still only a fraction of what it was before the ACA, so after my initial shock, I was able to put it in perspective and understand how this thing is still going through growing pains, but remains a godsend for me. The politics of this is so adversarial that the opposition party is determined to totally tear it down as revenge against the party (particularly OBAMA) that’s credited for giving it life, after decades of its evolution. The constant hammering, empty rhetoric and misrepresentations do not change the fact of its impact on me and countless others that I know and work with. So please stop making sweeping statements like “everybody” or “nobody” when it comes to attitudes about and impacts of this law. Let’s hope that the people elected to govern on behalf of ALL Americans will be more rational in considering the range of interests. It’s no simple task.

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