Lets look at the history of the Affordable Care Act, a.k.a. Obamacare. Back in 2008, then-presidential nominee Barack Obama ran a campaign with healthcare reform as one of its central issues. He advocated for universal healthcare but opposed an individual mandate. However, after input from experts that claimed that government-guaranteed healthcare would encourage too many free-riders, Obama decided to include an individual mandate as a central part of his healthcare reform efforts.
The individual mandate is largely credited as an idea by the conservative think-tank The Heritage Foundation as an alternative to a system in which the government pays for healthcare. It required each person to pay for their own healthcare and was proposed by Republicans during the Clinton era as a free-market solution that embodies the tenant of personal responsibility that Republicans claim to hold.
Once adopted by the Democrats and proposed in a bill on September 17, 2009, the Republicans staunchly opposed the measure. The Republicans, some of whom have been around long enough to have supported a similar bill during the Clinton administration, claimed that the individual mandate was an unconstitutional assault on freedom.
After 3 weeks of debate and town hall meetings, the bill passed through the House of Representatives and was sent to the Senate. The Democrats attempted to gain the support of moderate Republicans like Olympia Snowe, Bob Bennet, Mike Enzi, and Chuck Grassley. However, the moderate Republicans found themselves subject to intense pressure by the party to fall in line and oppose any healthcare reform effots.
The bill continued to be opposed by conservatives in the Senate who claimed that the bill's "public option" was a deal-breaker. The public option was government-run healthcare insurance that would be available to people alongside private health insurance in the market. Conservatives claimed that the public option would put private insurance out of business because the government is under no pressure to compete or turn a profit. After over 3 months of debate, the public option was dropped from the bill. Senator Grassley was quoted as saying:
"No public option. No play-or-pay. No things that are going to lead to any rationing of health care. No interference with the doctor-patient relationship," says Grassley. "About the only place we haven't made progress along the lines of what Republicans are wanting on the bill is in tort reform."
Despite this, it still took several last-minute concessions for conservatives to get the bill passed through the Senate on December 24, 2009, with support from independents and conservative Democrats to overcome the Republican threat of fillibuster.
The bill languished in the House of Representatives for 3 more months. In order to gets the admendments made to the bill back in the House, the Democrats had to win support from pro-life Representatives who worried that the bill would allow federal funds to be used to pay for abortions. To assuage anti-abortion politicians' fears, Barack Obama signed an executive order on March 21, 2010 to affirm that no federal funds could or would be used to fund abortions. The amendments were finally passed through the House and signed into law by Obama on March 23, 2010 (over 6 months after being proposed).
