Health Care Reform Background

The evolution of health care reform — from bills heard in committees to the laws signed by President Obama in March 2010 — was a long and complicated process. This section provides summaries of the various proposals, and describes the advocacy activity of CHA and other hospital groups.

The process began in spring 2009. The House released a bill that was amended independently in three committees: Ways and Means, Energy and Commerce, and Education and Labor. The Senate later released two separate bills. One was promptly passed by the Health, Education, Labor and Pensions Committee. The other was slowly developed by key senators on the Senate Finance Committee who become known as the “Gang of Six.” By the time the Senate Finance Committee voted on the bill, only four members of the Gang of Six supported it.

Once all committees passed their respective bills, they went to the House and Senate floors for a vote. In November, H.R. 3962, the Affordable Health Care for America Act, passed the House on a vote of 220-215, with one Republican voting in favor of the bill.

The Senate process required 60 votes to avoid a filibuster. After weeks of internal negotiating, the Senate Democrats and two Independents voted 60-40 in favor of H.R. 3590, the Patient Protection and Affordable Care Act.

In January, before the Senate and House were able to conference and pass one health care reform bill, Republican Scott Brown was elected to the Senate to replace the late Democrat Ted Kennedy. Without the 60-vote supermajority, the Democrats were unable to block a filibuster on a health care reform vote. Therefore, the Democratic leadership in the House created a “sidecar” reconciliation bill to make changes to the Senate bill. The reconciliation bill, H. R. 4872, the Health Care and Education Reconciliation Act of 2010, only required 51 votes in the Senate to pass.

The House passed H.R. 3590 on March 21, and it was signed by the President two days later. The reconciliation bill then went to the Senate where it was subject to strict process rules that required slight amendments. Although no health care provisions were changed, amendments were made to education provisions, which meant the bill had to return to the House. The amended reconciliation bill passed the House on March 25, and the President signed this last health care reform bill March 30, ending the long legislative process.