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[[File:View From the Speaker's Office Tonight (4452690853).jpg|thumb|right|[[Jim Clyburn]] and Nancy Pelosi celebrate after the House passes the amended bill on March 21.]]
[[File:View From the Speaker's Office Tonight (4452690853).jpg|thumb|right|[[Jim Clyburn]] and Nancy Pelosi celebrate after the House passes the amended bill on March 21.]]


ACA amended the [[Public Health Service Act of 1944]] and inserted new provisions on affordable care into [[Title 42 of the United States Code]].<ref name="Oberlander2010">{{cite journal |last1=Oberlander |first1=Jonathan |title=Long Time Coming: Why Health Reform Finally Passed |journal=Health Affairs |publisher=Project HOPE |oclc=07760874 |date=June 1, 2010 |volume=29 |issue=6 |pages=1112–1116 |doi=10.1377/hlthaff.2010.0447 |pmid=20530339 |issn=0278-2715|doi-access=free }}</ref><ref name="Blumenthal2015">{{cite journal |last1=Blumenthal |first1=David |last2=Abrams |first2=Melinda |last3=Nuzum |first3=Rachel |title=The Affordable Care Act at 5 Years |journal=New England Journal of Medicine |date=June 18, 2015 |volume=372 |issue=25 |pages=2451–2458 |doi=10.1056/NEJMhpr1503614 |pmid=25946142 |s2cid=28486139 |issn=0028-4793 |doi-access=free }}</ref><ref name="CohenEtAl">{{cite book |last1=Cohen |first1=Alan B. |last2=Colby |first2=David C. |last3=Wailoo |first3=Keith A. |last4=Zelizer |first4=Julian E. |title=Medicare and Medicaid at 50: America's Entitlement Programs in the Age of Affordable Care |date=June 1, 2015 |publisher=Oxford University Press |isbn=978-0-19-023156-9 |url=https://books.google.com/books?id=H9DGBwAAQBAJ}}</ref><ref name="24health">{{cite news |last1=Stolberg |first1=Sheryl Gay |last2=Pear |first2=Robert |title=Obama Signs Health Care Overhaul Bill, With a Flourish |url=https://www.nytimes.com/2010/03/24/health/policy/24health.html |work=The New York Times |issn=0362-4331 |oclc=1645522 |access-date=June 22, 2022 |archive-date=March 25, 2010 |archive-url=https://web.archive.org/web/20100325200505/https://www.nytimes.com/2010/03/24/health/policy/24health.html |page=A19 |date=March 23, 2010}}</ref><ref name="ReutersSCOTUS">{{cite news |last1=Vicini |first1=James |last2=Stempel |first2=Jonathan |author-link3=Joan Biskupic |last3=Biskupic |first3=Joan |title=Top court upholds healthcare law in Obama triumph |url=https://www.reuters.com/article/us-usa-healthcare-court-idUSBRE85R06420120628 |work=[[Reuters]] |date=June 28, 2017 |access-date=July 1, 2017 |archive-date=March 8, 2021 |archive-url=https://web.archive.org/web/20210308202215/https://www.reuters.com/article/us-usa-healthcare-court-idUSBRE85R06420120628 |url-status=live }}</ref> The individual insurance market was radically overhauled, and many of the law's regulations applied specifically to this market,<ref name="Oberlander2010" /> while the structure of Medicare, Medicaid, and the [[Health insurance in the United States#Employer sponsored|employer market]] were largely retained.<ref name="Blumenthal2015" /> Some regulations applied to the employer market, and the law also made delivery system changes that affected most of the health care system.<ref name="Blumenthal2015" />
ACA amended the [[Public Health Service Act of 1944]] and inserted new provisions on affordable care into [[Title 42 of the United States Code]].<ref name="Oberlander2010">{{cite journal |last1=Oberlander |first1=Jonathan |title=Long Time Coming: Why Health Reform Finally Passed |journal=Health Affairs |publisher=Project HOPE |oclc=07760874 |date=June 1, 2010 |volume=29 |issue=6 |pages=1112–1116 |doi=10.1377/hlthaff.2010.0447 |pmid=20530339 |issn=0278-2715|doi-access=free }}</ref><ref name="Blumenthal2015">{{cite journal |last1=Blumenthal |first1=David |last2=Abrams |first2=Melinda |last3=Nuzum |first3=Rachel |title=The Affordable Care Act at 5 Years |journal=New England Journal of Medicine |date=June 18, 2015 |volume=372 |issue=25 |pages=2451–2458 |doi=10.1056/NEJMhpr1503614 |pmid=25946142 |s2cid=28486139 |issn=0028-4793 |doi-access=free }}</ref><ref name="CohenEtAl">{{cite book |last1=Cohen |first1=Alan B. |last2=Colby |first2=David C. |last3=Wailoo |first3=Keith A. |last4=Zelizer |first4=Julian E. |title=Medicare and Medicaid at 50: America's Entitlement Programs in the Age of Affordable Care |date=June 1, 2015 |publisher=Oxford University Press |isbn=978-0-19-023156-9 |url=https://books.google.com/books?id=H9DGBwAAQBAJ}}</ref><ref name="24health">{{cite news |last1=Stolberg |first1=Sheryl Gay |last2=Pear |first2=Robert |title=Obama Signs Health Care Overhaul Bill, With a Flourish |url=https://www.nytimes.com/2010/03/24/health/policy/24health.html |work=The New York Times |issn=0362-4331 |oclc=1645522 |access-date=June 22, 2022 |archive-date=March 25, 2010 |archive-url=https://web.archive.org/web/20100325200505/https://www.nytimes.com/2010/03/24/health/policy/24health.html |page=A19 |date=March 23, 2010}}</ref><ref name="ReutersSCOTUS">{{cite news |last1=Vicini |first1=James |last2=Stempel |first2=Jonathan |author-link3=Joan Biskupic |last3=Biskupic |first3=Joan |title=Top court upholds healthcare law in Obama triumph |url=https://www.reuters.com/article/us-usa-healthcare-court-idUSBRE85R06420120628 |work=Reuters |date=June 28, 2017 |access-date=July 1, 2017 |archive-date=March 8, 2021 |archive-url=https://web.archive.org/web/20210308202215/https://www.reuters.com/article/us-usa-healthcare-court-idUSBRE85R06420120628 |url-status=live }}</ref> The individual insurance market was radically overhauled, and many of the law's regulations applied specifically to this market,<ref name="Oberlander2010" /> while the structure of Medicare, Medicaid, and the [[Health insurance in the United States#Employer sponsored|employer market]] were largely retained.<ref name="Blumenthal2015" /> Some regulations applied to the employer market, and the law also made delivery system changes that affected most of the health care system.<ref name="Blumenthal2015" />
{{Further|Commission on Key National Indicators}}
{{Further|Commission on Key National Indicators}}


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[[File:2017 House budget.pdf|thumb|2017 House Budget]]
[[File:2017 House budget.pdf|thumb|2017 House Budget]]


On February 3, 2015, the House of Representatives added its 67th repeal vote to the record (239 to 186). This attempt also failed.<ref>{{cite news |title=House votes -again-to repeal Obamacare |url=http://www.cnn.com/2015/02/03/politics/obamacare-repeal-vote-house/index.html |agency=[[Reuters]] |date=February 3, 2015 |author=Deirdre Walsh |access-date=February 4, 2015 |archive-date=January 25, 2021 |archive-url=https://web.archive.org/web/20210125112222/https://www.cnn.com/2015/02/03/politics/obamacare-repeal-vote-house/index.html |url-status=live }}</ref>
On February 3, 2015, the House of Representatives added its 67th repeal vote to the record (239 to 186). This attempt also failed.<ref>{{cite news |title=House votes -again-to repeal Obamacare |url=http://www.cnn.com/2015/02/03/politics/obamacare-repeal-vote-house/index.html |agency=Reuters |date=February 3, 2015 |author=Deirdre Walsh |access-date=February 4, 2015 |archive-date=January 25, 2021 |archive-url=https://web.archive.org/web/20210125112222/https://www.cnn.com/2015/02/03/politics/obamacare-repeal-vote-house/index.html |url-status=live }}</ref>


====2013 federal government shutdown====
====2013 federal government shutdown====
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In 2010 small business tax credits took effect.<ref name="hist">{{cite web |url=https://resources.ehealthinsurance.com/affordable-care-act/history-timeline-affordable-care-act-aca |title=History of the Affordable Care Act (ACA) |date=October 22, 2014}}</ref> Then [[Pre-existing Condition Insurance Plan|Pre-Existing Condition Insurance Plan]] (PCIP) took effect to offer insurance to those who had been denied coverage by private insurance companies because of a preexisting condition.<ref name="hist" /> By 2011, insurers had stopped marketing child-only policies in 17 states, as they sought to escape this requirement.<ref>{{Cite web |url=http://www.help.senate.gov/imo/media/doc/Child-Only%20Health%20Insurance%20Report%20Aug%202,%202011.pdf |title=Health Care Reforrm Law's Impact on Child-Only Health Insurance Policies |last=Enzi |first=Michael B. |date=August 2, 2011 |website=United States Senate |access-date=August 10, 2016}}</ref> In ''[[National Federation of Independent Business v. Sebelius]]'' the Supreme Court allowed states to opt out of the Medicaid expansion.<ref>{{cite web |last=Liptak |first=Adam |date=September 30, 2012 |location=Pittsburgh |url=http://www.post-gazette.com/stories/news/us/supreme-court-justices-face-important-rulings-in-upcoming-term-655566/ |title=Supreme Court justices face important rulings in upcoming term September |website=post-gazette.com |agency=The New York Times |access-date=September 30, 2012}}</ref><ref>{{Cite web |url=http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ |title=Status of State Action on the Medicaid Expansion Decision |publisher=[[Kaiser Family Foundation]] |access-date=August 12, 2016}}</ref><ref>{{cite web |last1=Walton |first1=Alice G. |title=How To Explain The Obamacare Ruling To A Five-Year-Old |url=https://www.forbes.com/sites/alicegwalton/2012/07/02/how-to-explain-the-obamacare-ruling-to-a-five-year-old/#23e103e723e1 |website=[[Forbes]]|access-date=May 5, 2017}}</ref>
In 2010 small business tax credits took effect.<ref name="hist">{{cite web |url=https://resources.ehealthinsurance.com/affordable-care-act/history-timeline-affordable-care-act-aca |title=History of the Affordable Care Act (ACA) |date=October 22, 2014}}</ref> Then [[Pre-existing Condition Insurance Plan|Pre-Existing Condition Insurance Plan]] (PCIP) took effect to offer insurance to those who had been denied coverage by private insurance companies because of a preexisting condition.<ref name="hist" /> By 2011, insurers had stopped marketing child-only policies in 17 states, as they sought to escape this requirement.<ref>{{Cite web |url=http://www.help.senate.gov/imo/media/doc/Child-Only%20Health%20Insurance%20Report%20Aug%202,%202011.pdf |title=Health Care Reforrm Law's Impact on Child-Only Health Insurance Policies |last=Enzi |first=Michael B. |date=August 2, 2011 |website=United States Senate |access-date=August 10, 2016}}</ref> In ''[[National Federation of Independent Business v. Sebelius]]'' the Supreme Court allowed states to opt out of the Medicaid expansion.<ref>{{cite web |last=Liptak |first=Adam |date=September 30, 2012 |location=Pittsburgh |url=http://www.post-gazette.com/stories/news/us/supreme-court-justices-face-important-rulings-in-upcoming-term-655566/ |title=Supreme Court justices face important rulings in upcoming term September |website=post-gazette.com |agency=The New York Times |access-date=September 30, 2012}}</ref><ref>{{Cite web |url=http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ |title=Status of State Action on the Medicaid Expansion Decision |publisher=[[Kaiser Family Foundation]] |access-date=August 12, 2016}}</ref><ref>{{cite web |last1=Walton |first1=Alice G. |title=How To Explain The Obamacare Ruling To A Five-Year-Old |url=https://www.forbes.com/sites/alicegwalton/2012/07/02/how-to-explain-the-obamacare-ruling-to-a-five-year-old/#23e103e723e1 |website=[[Forbes]]|access-date=May 5, 2017}}</ref>


In 2013, the [[Internal Revenue Service]] ruled that the cost of covering only the individual employee would be considered in determining whether the cost of coverage exceeded 9.5% of income. Family plans would not be considered even if the cost was above the 9.5% income threshold.<ref>{{cite news |author=The Editorial Board |date=February 2, 2013 |title=A Cruel Blow to American Families |url=https://www.nytimes.com/2013/02/03/opinion/sunday/a-cruel-blow-to-american-families.html |archive-url=https://web.archive.org/web/20130207214914/https://www.nytimes.com/2013/02/03/opinion/sunday/a-cruel-blow-to-american-families.html |archive-date=February 7, 2013 |issn=0362-4331 |oclc=1645522 |work=The New York Times}}</ref><ref>{{cite news |url=https://newrepublic.com/article/112327/obamacare-not-universal-you-thought |title=Not-So-Universal Health Care |last=Cohn |first=Jonathan |date=February 5, 2013 |magazine=[[The New Republic]]}}</ref> On July{{nbsp}}2 Obama delayed the employer mandate until 2015.<ref name="CohnDelay" /><ref name="treasurystatement" /><ref name="REG-138006-12" /> The launch for both the state and federal exchanges was beset by management and technical failings. [[HealthCare.gov]], the website that offers insurance through the exchanges operated by the federal government, crashed on opening and suffered many problems.<ref>{{cite news |last=Kennedy |first=Kelly |date=December 1, 2013 |newspaper=[[USA Today]] |url=https://www.usatoday.com/story/news/politics/2013/12/01/federalexchangmeetsgoal/3795523/ |title=White House claims success on HealthCare.gov repairs |access-date=December 1, 2013}}</ref> Operations stabilized in 2014, although not all planned features were complete.<ref>{{cite news |url=http://www.cnn.com/2013/10/22/politics/obamacare-website-four-reasons |title=Rough Obamacare rollout: 4 reasons why |last=Cohen |first=Tom |date=October 23, 2013 |publisher=CNN|access-date=November 5, 2013}}</ref><ref>{{cite news |url=http://www.csmonitor.com/USA/Latest-News-Wires/2013/1106/Senate-Democrats-frustrated-with-botched-rollout-of-Obamacare |title=Senate Democrats frustrated with botched rollout of Obamacare |last1=Holland |first1=Steve |date=November 6, 2013 |newspaper=The Christian Science Monitor |last2=Rampton |first2=Roberta |agency=[[Reuters]] |access-date=November 19, 2013}}</ref>
In 2013, the [[Internal Revenue Service]] ruled that the cost of covering only the individual employee would be considered in determining whether the cost of coverage exceeded 9.5% of income. Family plans would not be considered even if the cost was above the 9.5% income threshold.<ref>{{cite news |author=The Editorial Board |date=February 2, 2013 |title=A Cruel Blow to American Families |url=https://www.nytimes.com/2013/02/03/opinion/sunday/a-cruel-blow-to-american-families.html |archive-url=https://web.archive.org/web/20130207214914/https://www.nytimes.com/2013/02/03/opinion/sunday/a-cruel-blow-to-american-families.html |archive-date=February 7, 2013 |issn=0362-4331 |oclc=1645522 |work=The New York Times}}</ref><ref>{{cite news |url=https://newrepublic.com/article/112327/obamacare-not-universal-you-thought |title=Not-So-Universal Health Care |last=Cohn |first=Jonathan |date=February 5, 2013 |magazine=[[The New Republic]]}}</ref> On July{{nbsp}}2 Obama delayed the employer mandate until 2015.<ref name="CohnDelay" /><ref name="treasurystatement" /><ref name="REG-138006-12" /> The launch for both the state and federal exchanges was beset by management and technical failings. [[HealthCare.gov]], the website that offers insurance through the exchanges operated by the federal government, crashed on opening and suffered many problems.<ref>{{cite news |last=Kennedy |first=Kelly |date=December 1, 2013 |newspaper=[[USA Today]] |url=https://www.usatoday.com/story/news/politics/2013/12/01/federalexchangmeetsgoal/3795523/ |title=White House claims success on HealthCare.gov repairs |access-date=December 1, 2013}}</ref> Operations stabilized in 2014, although not all planned features were complete.<ref>{{cite news |url=http://www.cnn.com/2013/10/22/politics/obamacare-website-four-reasons |title=Rough Obamacare rollout: 4 reasons why |last=Cohen |first=Tom |date=October 23, 2013 |publisher=CNN|access-date=November 5, 2013}}</ref><ref>{{cite news |url=http://www.csmonitor.com/USA/Latest-News-Wires/2013/1106/Senate-Democrats-frustrated-with-botched-rollout-of-Obamacare |title=Senate Democrats frustrated with botched rollout of Obamacare |last1=Holland |first1=Steve |date=November 6, 2013 |newspaper=The Christian Science Monitor |last2=Rampton |first2=Roberta |agency=Reuters |access-date=November 19, 2013}}</ref>


The [[Government Accountability Office]] released a non-partisan study in 2014 that concluded the administration had not provided "effective planning or oversight practices" in developing the exchanges.<ref name="AP-20140731" /> In ''[[Burwell v. Hobby Lobby]]'' the Supreme Court exempted closely held corporations with religious convictions from the contraception rule.<ref name=":2" /> At the beginning of the 2015, 11.7 million had signed up (ex-Medicaid).<ref>{{Cite news |url=https://www.bloomberg.com/news/articles/2015-06-02/obamacare-dropouts-lead-to-enrollment-decline-of-1-5-million |title=Obamacare Sign-Ups Decline to 10.2 Million as Some Don't Pay |last=Tracer |first=Zachary |website=Bloomberg.com |date=June 2, 2015 |access-date=August 21, 2016}}</ref> By the end of the year about 8.8 million consumers had stayed in the program.<ref>{{Cite web |url=https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-11.html |title=December 31, 2015 Effectuated Enrollment Snapshot |date=March 11, 2016 |access-date=June 18, 2022 |archive-date=April 11, 2016 |archive-url=https://web.archive.org/web/20160411120015/https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-11.html |location=Baltimore, MD |publisher=Health and Human Services |website=cms.gov}}</ref> Congress repeatedly delayed the onset of the "[[Cadillac tax]]" on expensive insurance plans first until 2020<ref>{{Cite web |url=http://www.politico.com/story/2015/12/white-house-obamacare-cadillac-tax-216881 |title=How the White House lost on the Cadillac Tax |last=COOK |first=NANCY |date=December 16, 2015 |publisher=[[Politico]]|access-date=August 21, 2016}}</ref> and later until 2022 and repealed it in late 2019.<ref name="auto1"/>
The [[Government Accountability Office]] released a non-partisan study in 2014 that concluded the administration had not provided "effective planning or oversight practices" in developing the exchanges.<ref name="AP-20140731" /> In ''[[Burwell v. Hobby Lobby]]'' the Supreme Court exempted closely held corporations with religious convictions from the contraception rule.<ref name=":2" /> At the beginning of the 2015, 11.7 million had signed up (ex-Medicaid).<ref>{{Cite news |url=https://www.bloomberg.com/news/articles/2015-06-02/obamacare-dropouts-lead-to-enrollment-decline-of-1-5-million |title=Obamacare Sign-Ups Decline to 10.2 Million as Some Don't Pay |last=Tracer |first=Zachary |website=Bloomberg.com |date=June 2, 2015 |access-date=August 21, 2016}}</ref> By the end of the year about 8.8 million consumers had stayed in the program.<ref>{{Cite web |url=https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-11.html |title=December 31, 2015 Effectuated Enrollment Snapshot |date=March 11, 2016 |access-date=June 18, 2022 |archive-date=April 11, 2016 |archive-url=https://web.archive.org/web/20160411120015/https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-11.html |location=Baltimore, MD |publisher=Health and Human Services |website=cms.gov}}</ref> Congress repeatedly delayed the onset of the "[[Cadillac tax]]" on expensive insurance plans first until 2020<ref>{{Cite web |url=http://www.politico.com/story/2015/12/white-house-obamacare-cadillac-tax-216881 |title=How the White House lost on the Cadillac Tax |last=COOK |first=NANCY |date=December 16, 2015 |publisher=[[Politico]]|access-date=August 21, 2016}}</ref> and later until 2022 and repealed it in late 2019.<ref name="auto1"/>
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<ref name="Medicaiddeal">{{cite web |url=https://www.usnews.com/debate-club/is-medicaid-expansion-good-for-the-states |title=Is Medicaid Expansion Good for the States? |website=[[U.S. News & World Report]] |date=2012 |archive-url=https://web.archive.org/web/20120727073428/http://www.usnews.com/debate-club/is-medicaid-expansion-good-for-the-states |issn=0041-5537 |oclc=7786209 |archive-date=July 27, 2012 |access-date=June 21, 2022}} Arguments from seven [[subject-matter experts]].</ref>
<ref name="Medicaiddeal">{{cite web |url=https://www.usnews.com/debate-club/is-medicaid-expansion-good-for-the-states |title=Is Medicaid Expansion Good for the States? |website=[[U.S. News & World Report]] |date=2012 |archive-url=https://web.archive.org/web/20120727073428/http://www.usnews.com/debate-club/is-medicaid-expansion-good-for-the-states |issn=0041-5537 |oclc=7786209 |archive-date=July 27, 2012 |access-date=June 21, 2022}} Arguments from seven [[subject-matter experts]].</ref>


<ref name="most">{{cite news |last=Zengerle |first=Patricia |url=https://www.reuters.com/article/us-usa-campaign-healthcare-idUSBRE85N01M20120624 |title=Reuters-Most Americans Oppose Health Law But Like the Provisions |work=[[Reuters]]|date=June 24, 2012 |access-date=June 28, 2012}}</ref>
<ref name="most">{{cite news |last=Zengerle |first=Patricia |url=https://www.reuters.com/article/us-usa-campaign-healthcare-idUSBRE85N01M20120624 |title=Reuters-Most Americans Oppose Health Law But Like the Provisions |work=Reuters|date=June 24, 2012 |access-date=June 28, 2012}}</ref>


<ref name="multiple2">PriceWaterHouseCoopers. "The CLASS Act". HRS Insight: Human Resource Services. 2010: 1–6. Web.</ref>
<ref name="multiple2">PriceWaterHouseCoopers. "The CLASS Act". HRS Insight: Human Resource Services. 2010: 1–6. Web.</ref>
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<ref name="REG-138006-12">{{cite journal |last=Madara |first=Matthew R. |date=February 11, 2014 |title=ACA Employer Shared Responsibility Delay Included in Final Regs |journal=Tax Notes Today |volume=28 |issue=1}}</ref>
<ref name="REG-138006-12">{{cite journal |last=Madara |first=Matthew R. |date=February 11, 2014 |title=ACA Employer Shared Responsibility Delay Included in Final Regs |journal=Tax Notes Today |volume=28 |issue=1}}</ref>


<ref name="reuterstimeline">{{cite news |url=https://www.reuters.com/article/idUSTRE62L0JA20100322 |work=[[Reuters]]|title=Timeline: Milestones in Obama's quest for healthcare reform |date=March 22, 2010 |access-date=March 22, 2010}}</ref>
<ref name="reuterstimeline">{{cite news |url=https://www.reuters.com/article/idUSTRE62L0JA20100322 |work=Reuters|title=Timeline: Milestones in Obama's quest for healthcare reform |date=March 22, 2010 |access-date=March 22, 2010}}</ref>


<ref name="RollCallCBO">{{Cite news |title=CBO: Health Care Overhaul Would Cost $940&nbsp;Billion |first=Steven |last=Dennis |url=http://www.rollcall.com/news/44347-1.html |newspaper=[[Roll Call]] |date=March 18, 2010 |access-date=March 22, 2010}}</ref>
<ref name="RollCallCBO">{{Cite news |title=CBO: Health Care Overhaul Would Cost $940&nbsp;Billion |first=Steven |last=Dennis |url=http://www.rollcall.com/news/44347-1.html |newspaper=[[Roll Call]] |date=March 18, 2010 |access-date=March 22, 2010}}</ref>
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