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Historical Timeline
Passage of the March 2010 Health Care Reform Laws


Republican congressional representatives wave their bill on health care reform during President Obama's address to a joint session of Congress.
Republican congressional representatives wave their bill on health care reform during President Obama's address to a joint session of Congress.
Source: Luke Sharrett/The New York Times, www.nytimes.com, Sep. 9, 2009
During the 2008 US presidential election, then candidate Barack Obama (US Senator, D-IL) campaigned for the need to reform the American health care system, stating that the cost of health care was a "threat to our economy" and that health care should be a "right for every American." After assuming office in Nov. 2008, President Obama urged Congress to pass health care reform in weekly addresses, speeches, a nationally televised address to a joint session of Congress on Sep. 9, 2009, and his State of the Union addresses in 2009 and 2010.

Republican and Democrat congressional representatives introduced 133 health care and related bills during the 111th session of Congress (Jan. 2009 - Dec. 2009). Many Democrats supported measures such as the public option and individual mandate, while many Republicans opposed increasing government spending and control on health care. On Nov. 7, 2009 the House Democrats garnered a vote of 220-215 to approve the Affordable Health Care for America Act (HR 3962). Only one Republican, Anh Cao (R-LA), voted for the bill, and 39 Democrats voted against it. The bill was estimated to cost $1.1 trillion, provide coverage for 36 million uninsured Americans, and create a government health insurance program. The Congressional Budget Office (CBO) estimated that the bill would reduce the federal deficit by $118 billion over 2010-2019.

On Dec. 24, 2009 the Senate approved similar health care reform legislation called the Patient Protection and Affordable Care Act (HR 3590), in a 60-39 party-line vote. HR 3590 began as the Service Members Home Ownership Tax Act of 2009, a bill passed by the House on Oct. 8 that modified the homebuyers credit for members of the Armed Forces and certain other Federal employees. In a procedural move, the Senate co-opted HR 3590, removed all existing language, and replaced it with the language of their health care bill, the Patient Protection and Affordable Care Act. No Republican Senator voted for the bill. Some Republicans argued that the bill was unconstitutional, socialistic, too costly, and would increase health insurance costs for those who are already insured. This bill was estimated to cost $871 billion over 10 years, would require most Americans to have health insurance, and would extend coverage to 31 million uninsured Americans. The CBO estimated that the bill would reduce the federal deficit by $138 billion over 2010-2019.

Negotiations to reconcile the House and Senate bills stalled in Congress after Scott Brown (R-MA) won late Ted Kennedy's (D-MA) vacant Senate seat in Jan. 2010, causing Senate Democrats to lose their Republican filibuster-proof majority of 60 seats. On Feb. 22, 2010 President Obama unveiled his own proposal bridging the Senate and House health care bills, placing pressure on the House to pass health care reform legislation. House Democrats advanced the their amendments to HR 3590 as a new budget reconciliation bill, which is a form of legislation that requires only a simple majority and not a supermajority of 60 votes in the Senate to be approved.

Democrat congressional representatives walk into Capitol Hill to vote on health care reform bill HR 3590.
Democrat congressional representatives walk into Capitol Hill to vote on health care reform bill HR 3590.
Source: Chip Somodevilla/Getty Images, www.nytimes.com, Mar. 1, 2010
On Mar. 21, 2010 the House approved the Senate's bill (HR 3590) in a 219-212 vote and passed the House's amendments to HR 3590 as the Health Care and Education Reconciliation Act of 2010 (HR 4872) in a 220-211 vote. The Reconciliation Act made financing and revenue changes to HR 3590, while modifying higher education assistance financing. No Republican in the House voted for either HR 3590 or the reconciliation bill.

President Obama signed the Patient Protection and Affordable Care Act (HR 3590) (2.2 MB) into law on Mar. 23, 2010. This law was the main piece of legislation reforming the US health care system. The 906 page act was touted to increase health care coverage to include 32 million previously uninsured Americans. Under the new law, 95% of Americans will be insured, according to the White House website's "Putting Americans in Control of Their Health Care" page (accessed Mar. 29, 2010).

President Obama issued Executive Order 13535 (90 KB) on Mar. 24, 2010, to ensure that federal funds would not be used for abortion services, consistent with the Hyde Amendment (1.3 MB) , as he had promised anti-abortion Democrats.

On Mar. 25, 2010 the Senate approved the Reconciliation Act with amendments in a 56-43 vote, and the House approved the Senate's amended version of the act in a 220-207 vote. The Reconciliation Act (HR 4872) (283 KB) was signed into law by President Obama on Mar. 30, 2010 to make health-related financing and revenue changes to HR 3590 and to modify higher education assistance provisions.The CBO estimated that HR 3590 with the Reconciliation Act would reduce the federal deficit by $143 billion over 2010-2019, provide coverage for 32 million previously uninsured Americans, and require more Americans to have health insurance. The CBO's deficit reduction calculation has been disputed; some independent calcuations conclude the bills would raise the deficit by over $500 billion over the next 10 years.

The Patient's Bill of Rights (181 KB) , a summary of regulations issued by the US Departments of Health and Human Services (HHS), Labor, and Treasury, to implement the Patient Protection and Affordable Care Act, was released by the White House on June 22, 2010.

On Jan. 5, 2011 the new Republican-majority US House of Representatives introduced The Repealing the Job-Killing Health Care Law Act (HR 2) (144 KB) to repeal the Patient Protection and Affordable Care Act and health care related provisions in the Health Care and Education Reconciliation Act of 2010. On Jan. 19, 2011, the US House of Representatives passed the bill in a 245-189 vote. On Feb. 2, 2011, in a 51-47 party-line vote, the US Senate rejected The Repealing the Job-Killing Health Care Law Act.