Affordable Care Act Reconciliations: A Congressional Timeline

5 of 5 in Series: The Essentials of Healthcare Reform

The Patient Protection and Affordable Care Act (PPACA) or simply the Affordable Care Act (ACA) was signed by President Barack Obama on March 23, 2010. The ACA — what some refer to as "Obamacare" — passed through both houses of the US Congress. However, a 150-page set of fixes to the bill still had to be approved by the Senate before the larger bill's provisions could be implemented. The fixes, also called reconciliations, were added in order to reconcile differences between the House and Senate-approved bills.

The House approved the reconciliations at the same time they approved the larger healthcare bill. However, the next step of getting the fixes through the Senate wasn't an easy one. No Republicans were in favor of the bill as it had been voted into law, and many did everything within accepted parliamentary procedure to stop it.

During the next few days, Senators introduced an enormous number of amendments to the reconciliation and recommended content changes. While they had to spend 20 hours debating the fixes, they couldn't filibuster. Also, they only needed a simple, 51-vote majority to pass or fail any recommendation.

All content of the reconciliation had to deal directly with bill revenues or spending. If even one new amendment or content change got passed, no matter how minor, the bill would go back to the House and they would have to vote on it all over again.

Reconciliation legislation was voted on by the Senate 22 times and in every instance but one, the Senate made changes and sent the bill back to the House.

Although Democrats, who spearheaded passage of healthcare reform, had a 59-seat majority in the Senate, Republicans had publicly stated that they intended to introduce amendments they believe would be difficult for Democrats to vote against, especially in an election year.

If the fixes made their way back to the House contained major changes, there was a danger that they may not pass the second-time around. The reconciliations were a key factor in getting enough Democratic votes to push health reform through to passage.

Acting within his powers, the Senate Parliamentarian decided in March of 2010 that two provisions in the healthcare fixes bill must be removed because they violated reconciliation's strict budgetary rules.

The decision to remove the two provisions meant the bill would go back to the House for another vote, a move that delayed enactment of the healthcare reforms President Obama signed into law. The two sticking points, which Democrats described as minor, dealt with funding for Pell grants. Pell grants are government-issued funds that help low-income students pay for college. They expected and hoped the House would pass reconciliation once again.

With a vote of 56 to 43, the Senate passed healthcare reconciliation and sent the bill back to the House for a final vote. No additional changes to the healthcare reform fixes bill were made since the Senate Parliamentarian ruled two provisions dealing with Pell grant funding had to be removed.

The last barrier to enacting comprehensive healthcare reform was overcome in March of 2010 when, with a vote of 220 to 207, the House approved the fixes. Although the House had passed the reconciliations earlier that week, the Senate's removal of the Pell grant provisions forced the bill back to the House for a second vote.

President Obama signed the reconciliations into law the next week.

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The Essentials of Healthcare Reform

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