The Obama Presidency
President Obama and Vice President Biden applaud as the Health Care and Education Reconciliation Act passes in the House (Pete Souza/Official White House Photo)
On March 23, 2010, President Obama signed into law the Affordable Care Act (ACA), the most comprehensive revision of the American health care system since the introduction of Medicare and Medicaid in the 1960s. Obamacare—a term the president came to embrace—was designed to lower the number of Americans without health care insurance, which then stood at 15.7 percent. For the first time, insurance companies were required to accept all applicants, regardless of pre-existing conditions. The Act required all individuals (with a small number of exceptions) to carry health insurance or pay a tax penalty. Those on low incomes would receive subsidies to comply with this mandate. Medicaid eligibility was also expanded to include those earning 133 percent of the official poverty level. Though the legislation fell short of some liberal Democrats' hopes for a single payer system based on the Canadian or European model, the Act brought the dream of universal health coverage closer than ever before. That goal had eluded Democratic presidents from Harry Truman to Bill Clinton. Ultimately, the president's efforts to keep the GOP on board proved fruitless—not a single Republican in either the House or Senate supported it, although his compromises ensured enough support from moderate to conservative Democrats to eke out a narrow 219 to 212 vote in the House. (34 House Democrats voted against). The initial rollout of Obamacare suffered from teething troubles. Enrollees complained about premiums and limited coverage, and faced significant challenges in Court and attempts to repeal in Congress. To the surprise of many, Chief Justice John G. Roberts joined in the Supreme Court's 6-3 decision to uphold the ACA in King v. Burwell (2015). By 2016 the uninsured rate had fallen to a record 8.6 percent, nearly half the figure before Obamacare.