How U.S. Health Care Reform Works

By: Molly Edmonds

The Health Care Debate in 2009 and 2010

Though the health care reform proposals were frequently termed "Obamacare," the president took a hands-off approach in the initial creation of this legislation. As opposed to 1993, when the Clinton administration drafted much of its health care plan in isolation without input from Congress, Obama laid out his eight requirements for health care reform and then left it to Congress to write the bills.

Obama's eight principles for health care reform are:


  1. Assure affordable, quality health coverage for all Americans
  2. Remove obstacles to coverage for people with pre-existing conditions
  3. Maintain coverage in the event of job loss or change
  4. Safeguard families from bankruptcies related to health expenses
  5. Guarantee choice of doctors and coverage plans
  6. Shrink long-term cost increases in health care for businesses and the government
  7. Improve quality of care and patient safety
  8. Invest in preventive care and wellness

[sources: White House, Kaiser Family Foundation]

The House of Representatives and the Senate Health, Labor and Pensions (HELP) Committee released bills in the summer of 2009, both of which featured a public option in which the government would sponsor a health care plan (the Senate Finance Committee released its bill without this option in the fall). During the summer recess, lawmakers faced protests and harsh words at town hall meetings in their districts, as conservatives decried the proposals as socialist. Though President Obama delivered a speech in September to address criticisms and clear up misunderstandings about the proposals, pundits wondered whether the bills were dead in the water.

The House of Representatives passed its bill in November, but with a major concession deemed necessary to get the adequate votes: The bill carried with it an amendment that public funds could not be used to pay for abortions. The Senate passed its bill in December, with another major concession: Democrats agreed to drop a public insurance option. With the two votes completed, the process of reconciling the two bills into one began.

When Republican Scott Brown was elected to fill Democrat Ted Kennedy's senate seat in Massachusetts, the pundits again wondered if health care reform was dead. The Democrats had lost their filibuster-proof majority, which would have allowed them to pass health care without Republican assistance, something the Republicans had made quite clear they wouldn't provide. Obama made one final reach to the party on Feb. 25, 2010, when he hosted a bipartisan health care summit, which many conservatives considered a publicity stunt.

To avoid a filibuster in the Senate, the House elected to adopt the Senate's bill, and that's what they passed on March 21, along with a separate bill of changes. By voting this way, the bill of amendments would only require a simple majority of 51 votes. When the dust had settled on the political wrangling, the Patient Protection and Affordable Care Act was signed into law. But what does it actually say?