Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (H.R. 3590), occasionally dubbed 'ObamaCare', was signed into law by Barack Obama on March 23, 2010. It was the result of a roughly 11-month campaign by the Democratic Party to pass sweeping healthcare changes. Despite a Supermajority held during much of this time, which prevented Republicans from having the votes necessary to stop bills, 40 Pro-Life Democrats in the House united under their leader, Bart Stupak, to stall the House bill until it finally included the Pro-Life Stupak amendment (November 8, 2009). However, the Senate then refused to pass the House bill, tabling it indefinitely, and passed its own bill in December 2009 so the abortion agenda could be reinserted into healthcare. The two bills were then combined in a complicated process called 'Reconciliation', but the bill had to go back to the House for approval. Bart Stupak ultimately settled for an Executive Order from Barack Obama, essentially a presidential promise that abortion would not be funded in the bill, after which he and roughly half the Pro-Life Democrats voted in favor of the Reconciliation process, narrowly passing the bill. The other half of Pro-Life Democrats voted against the bill, several with strong misgivings.

Background
Obama during the 2008 elections had campaigned on healthcare reform, promising that the negotiations would not be behind closed doors, but televised publicly on C-Span. He had also promised Planned Parenthood on July 17, 2007, that "reproductive care" would be central to the coming healthcare bill, and that he believed it important for Planned Parenthood to be part of the system :

"Well, look, in my mind, reproductive care is essential care. It is basic care. So it is at the center and at the heart of the plan that I propose... Essentially what we are doing is to say that we're going to set up a public plan that all persons, and all women, can access if they don't have health insurance. It'll be a plan that will provide all essential services, including reproductive services, as well as mental health services, and disease-management services, because part of our interest is to make sure that we're putting more money into preventive care. And so many of women's diseases are preventable if they're getting access to regular care. So we subsidize women who don't have health insurance, or can't afford low group rates. We also will subsidize those who prefer to stay in the private insurance market, except the insurers are going to have to abide by the same rules in terms of providing comprehensive care, including reproductive care, and mental care services, and they won't be able to keep people out as a consequence of pre-existing conditions. So, that's going to be absolutely vital... I still believe that it is important for organizations like Planned Parenthood to be part of that system, because many young women for example may be much more comfortable when they're in college, or universities, or in other places, going to Planned Parenthood clinics and services, to get contraception, for example." -Barack Obama before Planned Parenthood, July 17, 2007

Supermajority
On April 28, 2009, the 2008 Wall Street Journal's prediction of a 'Liberal Supermajority' proved correct; as the defection of Senator Arlen Specter from the Republican Party to the Democratic Party put the Democrats on the verge of one of the rarest blessings in politics, a Supermajority - complete control of the House, Senate, and Presidency so that they wouldn't need a single Republican vote to pass bills. Senator Bernie Sanders then urged the Democrat party to pursue single-payer healthcare reform. On May 16, 2009, Barack Obama urged Congress to pass health care reform within the year, stating, "Our businesses will not be able to compete; our families will not be able to save or spend; our budgets will remain unsustainable unless we get health care costs under control". On July 1, 2009, Al Franken was finally declared the winner of his election (narrowly winning by 312 votes ), giving the Democrats their desired Supermajority, and a clear path towards healthcare reform which Republicans would be powerless to stop. Nevertheless, sickness of Ted Kennedy and Robert Byrd along with several other facts led to question marks about the supermajority's strength. Democrats maintained this Supermajority until February 5, 2010, when Republican Scott Brown was sworn in to replace deceased Senator Edward Kennedy.

Locking Out Republicans, Literally
Democrats were so confident that the 2008 elections displayed American backing for the Democratic Party that in October 2009 they even changed the door locks for the House Oversight and Government Reform Committee to keep Republicans from meeting when Democrats weren't present. The debacle occurred because Republicans were trying to launch an investigation into corruption by Democrat Senators Kent Conrad and Chris Dodd for receiving special VIP loans from Countrywide Financial. Democrats canceled the meeting by secretly leaving before the meeting was to begin, and a GOP staffer caught this on videotape, set it to the tune of "Hit the Road, Jack", and posted it on the Oversight and Government Reform Committee’s minority webpage for the press. Committee Chairman Sen. Edolphus Towns and the Democrats then had the locks changed in retaliation.

Public Option Removed
On July 8, 2009, Barack Obama met with hospital lobbyists and struck a deal with the hospital industry to remove the public option in exchange for the industry's support of the bill, while also reducing costs for hospitals under the plan. "Not to worry, Jim Messina, the deputy White House chief of staff, told the hospital lobbyists, according to White House officials and lobbyists briefed on the call. The White House was standing behind the deal, Mr. Messina told them, capping the industry’s costs at a maximum of $155 billion over 10 years in exchange for its political support... Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying Medicare rates — generally 80 percent of private sector rates — or controlled by the secretary of health and human services. 'We have an agreement with the White House that I’m very confident will be seen all the way through conference,' one of the industry lobbyists, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter." -David Kirkpatrick, New York Times, Obama is Taking an Active Role in Talks on Health Care Plan

In November 2009, an amendment proposed by Dennis Kucinich to let states have single-payer healthcare systems without insurance industry lawsuits was stripped from the healthcare bill because Nancy Pelosi said it would break Obama's promise to let people keep their current insurance plans if they liked them. Kucinich expressed frustration with the move, stating, "They took single-payer off the table right at the beginning, because the table was set by insurance companies." On March 25, 2010, Obama claimed the public option wasn't included "Because we couldn"t get it through Congress, that's why." He also on December 22, 2009 erroneously claimed that he hadn't campaigned on a public option. Following Obama's claim, a liberal group, The Progressive Change Campaign Committee, began airing television ads accusing Obama of breaking his promise of a single-payer healthcare plan.

Tax on Medical Device Makers
The only healthcare industry to not readily acquiesce to the administration's demands for cooperation, medical device manufacturers, were hit with a 2.3% excise tax. The Wall Street Journal suggested this was due to retaliation since the tax would add just $40 billion in funds for a bill costing $900 billion. Medical device makers continue to accuse the tax of costing jobs in 2012.

Stupak's Resistance
In June and July 2009 some 200 Planned Parenthood activists arrived in Washington and a number of Pro-Choice bills began receiving support, as the Pro-Choice movement sought to ensure abortion would be mandated in health care reform. The Republicans would find an unlikely ally in the Pro-Life Democrats (Democrats for Life of America). On June 25, 2009, 19 of them sent a letter to House leader Nancy Pelosi expressing refusal to support any healthcare bill with an abortion agenda, which firmly stated, "Therefore, we cannot support any health care reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan... By ensuring that abortions are not funded through any health care reform package, we will take this controversial issue off the table so that Congress can focus on crafting a broadly-supported health care reform bill."

In July, Stupak introduced the Stupak-Pitts amendment to ensure abortions would not be subsidized in the healthcare bill, but it was defeated 30-29 in the Energy and House Committee, the committee responsible for drafting it for proposal to the entire House of Representatives, when Bart Gordon sneakily switched his vote from Yes to No last minute. Chairman Henry Waxman replaced it with the Capps amendment, which mandated one healthcare plan in each state must cover abortions. On July 17, 2009, Obama once more urged rapid passage of the healthcare bill. Pro-Life Democrats then, in mid-July, nearly stopped the healthcare process in its tracks by initially defeating a rule required to start healthcare reform legislation, 215-214, but Democrats managed to persuade a few members to change their votes, barely passing it.

Obama on July 16 pressured Republicans to support the healthcare bill, even as the Congressional Budget Office criticized the proposed healthcare reform for not paying for itself. Republicans criticized the lack of tort reform and insistence on covering 5.6 million illegal immigrants. Obama predicted he would be held responsible if the bill failed, stating: "You know, I intend to be president for a while and once the bill passes, I own it. And if people look and say, 'You know what? This hasn't reduced my costs. My premiums are still going up 25 percent, insurance companies are still jerking me around,' I'm the one who's going to be held responsible."

Obama initially claimed that allegations of abortion in the healthcare bill were "fabrications" by "people who are bearing false witness." On August 21, he said, in a radio talk show, that claims of abortion in the bill were "not true". However, a detailed FactCheck.org analysis concluded Obama went too far in decrying claims of abortion in healthcare as fabrications, since his own previous promise of "reproductive services" in the bill coupled with the bill's wording showed that abortion likely would be subsidized by government under the bill. On September 9, Obama continued to assert the bill would not fund abortions, promising immediately after Joe Wilson famously stood up and yelled "You lie!", that "Under our plan, no federal dollars will be used to fund abortions."

In late September after 31 different Pro-Life Democrats had signed various letters opposing abortion in the healthcare bill, Nancy Pelosi and Obama began meeting with their leader, Bart Stupak, for the first time. Stupak denied claims that he was trying to "kill" healthcare reform, stating publicly at the time, "I believe we need comprehensive healthcare reform and I am excited that we are closer than we have ever been to passing a healthcare reform bill in Congress. But any reform must address legitimate concerns, including using public funding for abortions, even if party leaders disagree." On October 21, a coalition of Pro-Life groups led by key Republicans, including Mike Pence, delivered a petition signed by 137,000 Americans to Congress expressing disapproval with the healthcare reform legislation.

Bill Introduced
On October 26, the House healthcare bill was unveiled, a 1,930 page piece of legislation, the Affordable Healthcare for America Act (H.R. 3962). Representative Mike Pence (R-IN) accused the bill of being a "government takeover of health care in America". By early November, the House was trying to pass the healthcare bill but Bart Stupak claimed 40 Pro-Life Democrats could vote with him if his Stupak-Pitts Amendment was not voted on to prevent abortion funding in the bill. With 218 votes required for passage, this would derail the historic vote set to occur on November 7. While Senate Leader Harry Reid (D-UT) sought to create a separate bill in the Senate, he continued to lack the 60 votes needed for a public option, i.e. a government insurance program.

Passage
Bart Stupak and his 40 Pro-Life Democrats refused to budge, and Pelosi until the last day tried to play 'chicken', denying the Stupak Amendment its vote. On November 7 Obama made personal last-minute contact with moderate Democrats in an attempt to persuade them to vote for the healthcare bill without Stupak's amendment. A desperate Nancy Pelosi met with Bart Stupak last-minute and at his request, the Conference of Catholic Bishops, ultimately allowing the Stupak-Pitts amendment its vote, which passed by a vote of 240-194. While some Republicans had considered voting 'Present' on the Stupak amendment to defeat it and thus perhaps healthcare reform, Pro-Life groups opposed the strategy and were scoring the vote so less than a 'Yes' would change a member's perfect Pro-Life rating. Republican House leader John Boehner confronted Democrat Charles Rangel on the House floor, asking whether the Stupak language would be preserved in the final bill or removed in the end, stating, "I have my doubts this language if it passes has any chance of being in the final version of this bill". Boehner refused to vote for the bill without a guarantee the language would be kept.

"Republican congressional leaders have to be chuckling right now. In the end, all the tea-party town halls, Glenn Beck rallies and 'death panel' rumors may have less of a hand in bringing down health care reform than an intraparty Democratic culture war. Congressman Bart Stupak of Michigan, whose amendment restricting abortion coverage on all policies sold through the new insurance exchange paved the way for passage of health reform in the House of Representatives, vows that 'there will be hell to pay' if his language gets stripped out of, or weakened in, the final legislation." -Amy Sullivan, Time Magazine, Can Dems Resolve Their Abortion Split?

On November 8, 2009, the House healthcare bill, newly amended with the Pro-Life Stupak-Pitts amendment, narrowly passed the House by a vote of 220-215. Joseph Cao was the only Republican to vote in favor of the bill. 39 Democrats still voted against the bill, including many fiscally conservative Blue Dog Democrats and socially conservative Pro-Life Democrats affiliated with DFLA.

Reaction
Afterwards, Obama stressed that it was time for the Senate to "take the baton." Several Democrats including Debbie Wasserman Schultz (D-FL) revealed they voted for the bill only with the understanding that it would be removed from the final bill version. The passage of Stupak's Pro-Life amendment in the House healthcare bill led to a letter signed by 40 Pro-Choice Senate Democrats, led by Dianna DeGette, saying that they would not pass healthcare reform unless Stupak's amendment was removed, even as Senate Pro-Life Democrats vowed to reject any bills with abortion agendas. Senator Ben Nelson (D-NE) promised, "If it isn’t clear that government money is not to be used to fund abortions, I won’t vote for it," and Obama assured that "This is a health-care bill, not an abortion bill."

On the Pro-Life side, a website, StopTheAbortionMandate.com, was created, and Susan's B. Anthony's List, an anti-abortion group, fund-raised in attacks on the bill, receiving contributions over 50% above the previous year's levels, which it used in advertising attacks on Sen. Harry Reid. On the Pro-Choice side, Stupak's stand drew the anger of liberal groups. The Progressive Change Campaign Committee performed three "Stop Stupak" fundraisers and began issuing attack ads against him in his home state of Michigan. CNN's Rachel Maddow predicted a revolt among women.

Democratic Senator Barbara Boxer vowed to keep the Stupak-Pitts amendment from passing in the Senate. White House Senior Advisor David Axelrod claimed Obama would intervene to change the Stupak language, and Stupak responded with "They're not going to take it out. If they do, health care will not move forward,. We won fair and square. ... That's why Mr. Axelrod's not a legislator. He doesn't really know what he's talking about." Polls taken in mid-November showed public support for the Pro-Life Democrat position. 61% of Americans, according to a CNN/Opinion Research Corp. survey, oppose using federal money for abortions, while a CBS News poll found 56% oppose federal subsidies for abortions.

Senate Bill: H.R. 3962
On November 18 the U.S. Senate under Senate Leader Harry Reid introduced its own health care bill (H.R. 3962 The Affordable Health Care for America Act), separate from the House bill. Obama called this bill a 'milestone' and urged Congress to pass it quickly.

Senator Ben Nelson of Nebraska attempted to introduce the Nelson Amendment, a Pro-Life amendment identical to the Stupak-Pitts amendment, but it was defeated 54-45 on December 8. Four Senators stood in the way of the bill's passage, Ben Nelson, Mary Landrieu, Blanche Lincoln, and Joe Lieberman. By December 16th, both Landrieu and Lieberman had agreed to support the bill since its public option and Medicare expansions were removed. Lieberman agreed only on condition that Medicare not be expanded to include Seniors as young as 55. Landrieu in the process agreed to take $100 million in Medicaid money for her state, and was accused by Republican John Cornyn as having been "bribed". "We are approaching the eve of Christmas and maybe in that spirit, Senate Majority Leader Harry Reid morphed into Santa Claus, giving out presents to the little boys and girls who were naughty and (not so) nice this year. Of course, he was not using his own money. America's overused credit card, issued by the Bank of China, may have to be used one more time to pay for Reid's deals. The majority leader traded to help ensure the votes of Sens. Ben Nelson, Mary Landrieu, Chris Dodd, Bernie Sanders and others representing 11 states by giving them special perks for staying on the health care bus that's about to drive us all over the financial cliff." -Ed Rollins, Harry Reid Playing Santa With Your Money, CNN. On December 19 following 13 hours of negotiations, Senator Nelson finally agree to back the Senate bill in exchange for tighter restrictions on abortion and increased Medicaid funding for his state. The National Right to Life Committee opposed Nelson's compromise and said it was "light years removed" from the House bill's language per the Stupak Amendment. A day later, both the RNC and Rick Santorum then initiated a robocall to 100,000 Nebraskans asking them to call Ben Nelson and ask him to reconsider. On December 22nd, the GOP led by John McCain began accusing Nelson of a "Cornhusker Kickback" because his state had received $45 million of Medicare funding in the deal. Nelson denied this, claiming "I didn't ask for a special favor here". Landrieu's deal was likewise criticized as the "Louisiana Purchase".

Both the AARP and American Medical Association ran ads urging Senators to vote for the bill. On December 24, 2009, the Senate passed its bill on a party-line vote, 60-39, without a single Republican vote.

Reconciliation
The possibility of splitting healthcare into two bills and reconciling them was rumored as early as August 20, 2009.

Effort to Repeal
The Individual Mandate requiring U.S. citizens to buy healthcare will be going before the U.S. Supreme Court as potentially unconstitutional sometime in Summer 2012. It is possible the entire bill could end up getting repealed. A CBS News/New York Times poll taken March 21-25, 2012, found that just 26% of Americans want the Supreme Court to keep the entire healthcare law intact.

Obama criticized the Supreme Court for considering the case, saying to overturn the bill would be "unprecedented" and was criticized by Senate Republican Leader Mitch McConnell, who said he should "back off. Let the Court do its work. Let our system work the way it was intended." Following this, Obama conceded the Supreme Court does have the power to overturn the bill.

The Congressional Budget Office in 2011 projected that repealing the bill would add $211 billion to the deficit, but this was contradicted in April 2012 by economist Charles Blahouse who said the bill adds $340 billion to the deficit.