The Patient Protection and Affordable Care Act was signed into law by President Obama in March 2010. Its major provisions go into effect in Jan. 1, 2014, although significant changes went into effect before that date and will continue in years to come.
The Act affirms “the core principle that everybody should have some basic security when it comes to their health care,” Obama said at the signing.
It is commonly known as the Affordable Care Act — and widely nicknamed Obamacare. The Act will extend insurance to more than 30 million uninsured people, primarily by expanding Medicaid and providing federal subsidies to help lower- and middle-income Americans buy private coverage.
As a candidate, Obama proposed what became “the largest middle-class tax cut for health care in history.” In the general election it was a cornerstone of his campaign.
The concept was hardly new, however. Democratic presidents had unsuccessfully pursued the creation of a nationwide insurance system for 75 years. At the 2010 signing, Obama noted that it was a law that “generations of Americans have fought for and marched for and hungered to see.”
The final hurdle was cleared in June 2012, when the Supreme Court upheld most provisions of the health care law. (Read the Supreme Court’s rulings on the Affordable Care Act and justices’ rebuttals.)
Twenty-six states and the National Federation of Independent Business had brought suit in federal court challenging the mandate that individuals carry insurance or pay penalties, as well as the expansion of Medicaid. The Supreme Court ruled that states could not be forced into cooperating with the Medicaid expansion, but left most of the other provisions intact.
Much of the Obamacare political action came in 2009, the first year of the presidency. On July 14, House Democrats introduced a 1,000-page plan for overhauling the health care system. The debate raged throughout the summer and beyond.
“This so-called public option is going to force millions of Americans out of their private health insurance into a government-run plan,” charged House leader John Boehner.
On Sept. 9, 2009, Obama addressed critics via a joint session of Congress. He cited a letter sent to him from Sen. Ted Kennedy, who had died a few weeks earlier. Kennedy, who battled for health care reform throughout his career, said it was above all a “moral issue” that addressed the “fundamental principles of social justice.”
Republican Rep. Joe Wilson, in a major breech of U.S. political tradition, yelled “you lie!” after Obama said his plan would not apply to illegal immigrants. The Senate health care-reform plan, introduced a week later, specifically prohibited participation by those “not lawfully present” in the U.S.
On Nov. 7, the U.S. House approved its version with a 220-215 vote. The Senate passed its version Dec. 24, in a 60-39 vote.
The Senate bill was amended and then OK’d by the House (as HR 3590) in a 219-212 vote of March 21, 2010. All Republicans voted against it.
Addressing the many concerns expressed nationwide, the Act pointed out that “nothing in this act or anywhere in the bill forces anyone to change the insurance they have, period.” It vowed a “new transparent and competitive insurance marketplace.”
Obama was re-elected November 2012, defeating the GOP candidate who promised to dismantle Obamacare. The re-election effectively ensured the Act would become reality.
View the Affordable Care Act timeline.