H.R.3590: Patient Protection and Affordable Care Act

Bill history
After his inauguration, President Obama announced to a joint session of Congress in February 2009 that he would begin working with Congress to construct a plan for health care reform

On March 5, 2009, Obama formally began the reform process and held a conference with industry leaders to discuss reform and requested reform be enacted before the Congressional summer recess; but the reform was not passed by the requested date. In July 2009, a series of bills were approved by committees within the House of Representatives

On November 7, After reconvening from that summer's recess, the House of Representatives passed the Affordable Health Care for America Act [Affordable Health Care for America Act] on a 220–215 vote and forwarded it to the Senate for passage.

The Senate failed to take up debate on the House bill and instead took up H.R. 3590 [H.R. 3590 Patient Protection and Affordable Care Act], a bill regarding housing tax breaks for service members. As the United States Constitution requires all revenue-related bills to originate in the House, the Senate took up this bill since it was first passed by the House as a revenue-related modification to the Internal Revenue Code. The bill was then used as the Senate's vehicle for their health care reform proposal, completely revising the content of the bill. The bill as amended incorporated elements of earlier proposals that had been reported favorably by the Senate Health and Finance committees.

Passage in the Senate was temporarily blocked by a filibuster threat by Nebraska Senator [Ben Nelson], who sided with Republican minority. Nelson's support for the bill was won after the bill was amended to offer a higher rate of Medicaid reimbursement for Nebraska. The compromise was derisively referred to as the "Cornhusker Kickback" (and was later repealed by the reconciliation bill). On December 23, the Senate voted 60–39 to end debate on the bill, eliminating the possibility of a filibuster by opponents. The bill then passed by a party-line vote of 60–39 on December 24, 2009, with one senator [Jim Bunning] not voting.

On January 19, 2010, Republican [Scott Brown] was elected to the Senate, giving the Republican minority enough votes to sustain a filibuster in the future. Following Brown's Senate win, the fate of the health care reform was uncertain. White House Chief of Staff Rahm Emanuel argued for a less ambitious bill, while House Speaker [Nancy Pelosi] pushed back, dismissing Emanuel's scaled-down approach as "Kiddie Care"  Obama's siding with comprehensive reform and the news that Anthem Blue Cross in California intended to raise premium rates for its patients by as much as 39% gave him a new line of argument for reform. Obama unveiled a health care reform plan of his own, drawing largely from the Senate bill. On February 25, he held a meeting with leaders of both parties urging passage of a reform bill. The summit proved successful in shifting the political narrative away from the Massachusetts loss back to health care policy.

The most viable option for the proponents of comprehensive reform was for the House to abandon its own health reform bill, the [Affordable Health Care for America Act], and to instead pass the Senate's bill, and then pass amendments to it with a different bill allowing the Senate to pass the amendments via the reconciliation process

Initially, there were not enough supporters to pass the bill requiring its proponents to negotiate with a group of pro-life Democrats, led by Congressman [Bart Stupak]. The group found the possibility of federal funding for abortion was substantive enough to cause their opposition to the bill. Instead of requesting inclusion of additional language specific to their abortion concerns in the bill, President Obama issued Executive Order 13535, reaffirming the principles in the Hyde Amendment. This concession won the support of Stupak and members of his group and assured passage of the bill

The House passed the bill with a vote of 219 to 212 on March 21, 2010, with 34 Democrats and all 178 Republicans voting against it The following day, Republicans introduced legislation to repeal the bill. Obama signed the bill into law on March 23, 2010.