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111th Congress, Vote 165; House of Representatives #3590

Affordable Care Act (Obamacare)

Official Title: An act entitled The Patient Protection and Affordable Care Act.

HR 3590: Patient Protection and Affordable Care Act
Passed House March 21, 2010, 219-212.

Obama signs health care reform legislationSynopsis: This was originally a health reform bill created by the Senate. The negotiations that led to it were essentially between the White House and Democrats in the House and Senate, since Republicans were unanimous in opposing the bill. There was much concern among progressives about the compromises Senate Democrats were willing to make to get the bill approved; for instance, they dropped the idea of public option health plan.

This bill requires most Americans to have health insurance, and mandates the creation of health insurance exchanges in each state to provide a simple, affordable way for consumers to purchase insurance if they don't already receive coverage from an employer. The bill was estimated to reduce the number of Americans without health coverage by 32 million over 10 years.

Opponents of the bill argued that it allowed too great a role for government in health insurance and was too costly. They vowed to try to repeal it and find ways to eliminate funding for some of its provisions.

Why supporters pushed for the bill

  • The PPACA addresses the needs of the 46 million uninsured Americans;
  • strengthens the Medicare system by closing the donut hole in prescription coverage, and cutting waste and fraud while guaranteeing preventive care without co-pays;
  • provides health insurance to low-income children;
  • funds cutting-edge research into cures for diseases;
  • gives patients the clout to challenge the decisions of health insurers and;
  • increases access to care by making it impossible for insurers to shun the sick.

In the past, insurers either refused to cover patients suffering from pre-existing conditions, or charged them unaffordable premiums. As House Speaker Nancy Pelosi noted shortly before the legislation passed: "If you're a woman that's a pre-existing condition; if you're a woman of child-bearing age and you've had children that's a pre-existing condition. If you can't have children, it's a pre-existing condition. If you have a C-section, it's a pre-existing condition. A victim of domestic abuse, it's a preexisting condition."

Under the PPACA, Americans would no longer have to worry about being denied insurance. Pelosi urged her audience to "Think of an economy where people could be an artist or a photographer, a writer without worrying about keeping their day job in order to have health insurance. Or that people could start a business and be entrepreneurial and take risks, but not be job-locked because a child has a child has asthma or diabetes or someone in the family is bipolar …"

Why opponents tried to stop the bill

  • The PPACA would fund healthcare for the uninsured, opponents argued, by cutting Medicare spending.
  • Reform legislation does not include what many call "meaningful malpractice reform." If we want to make health care affordable, opponents insist, Congress must either cap malpractice awards or find some other way of reducing the likelihood that a physician will be sued. Otherwise, physicians will continue to practice "defensive medicine" – running unneeded tests, and hospitalizing patients because they fear that if they don't, they will be sued.
  • Opposition argued that the PPACA is unaffordable, and will only add to the deficit. Robert Book, a health economist at the conservative Heritage Foundation, responded to House Majority Leader Nancy Pelosi's statement that – according to the Congressional Budget Office – the PPACA would cut the deficit by $138 billion in the first ten years (2010-2019) and "by $1.2 trillion in the second 10 years."

    Book said "Pelosi's deficit reduction number – extrapolated from a forecast of the GDP – is highly speculative," adding that "GDP estimates are extremely uncertain. Ten years ago, who would have predicted we'd have a recession last year? Nobody could possibly have known that."
03/21/2010 Status: House passed

More: select a member to see his or her other key health care votes.

Yes (219)
Our pick
D Victor Snyder AR
D Gabrielle Giffords AZ
D Raúl Grijalva AZ
D Ann Kirkpatrick AZ
D Harry Mitchell AZ
D Ed Pastor AZ
D Joe Baca CA
D Xavier Becerra CA
D Howard Berman CA
D Lois Capps CA
D Dennis Cardoza CA
D Judy Chu CA
D Jim Costa CA
D Susan Davis CA
D Anna Eshoo CA
D Sam Farr CA
D Bob Filner CA
D John Garamendi CA
D Jane Harman CA
D Michael Honda CA
D Barbara Lee CA
D Zoe Lofgren CA
D Doris Matsui CA
D Jerry McNerney CA
D George Miller CA
D Grace Napolitano CA
D Nancy Pelosi CA
D Laura Richardson CA
D L. Roybal-Allard CA
D Linda Sánchez CA
D Loretta Sanchez CA
D Adam Schiff CA
D Brad Sherman CA
D Jackie Speier CA
D Fortney Stark CA
D Mike Thompson CA
D Maxine Waters CA
D Diane Watson CA
D Henry Waxman CA
D Lynn Woolsey CA
D Diana DeGette CO
D Betsy Markey CO
D Ed Perlmutter CO
D Jared Polis CO
D John Salazar CO
D Joe Courtney CT
D Rosa DeLauro CT
D James Himes CT
D John Larson CT
D Christopher Murphy CT
D Allen Boyd FL
D Corrine Brown FL
D Kathy Castor FL
D Alan Grayson FL
D Alcee Hastings FL
D Ron Klein FL
D Suzanne Kosmas FL
D Kendrick Meek FL
D D. Wasserman Schultz FL
D Sanford Bishop GA
D Henry Johnson GA
D John Lewis GA
D David Scott GA
D Mazie Hirono HI
D Leonard Boswell IA
D Bruce Braley IA
D David Loebsack IA
D Melissa Bean IL
D Jerry Costello IL
D Danny Davis IL
D Bill Foster IL
D Luis Gutiérrez IL
D Deborah Halvorson IL
D Phil Hare IL
D Jesse Jackson IL
D Mike Quigley IL
D Bobby Rush IL
D Janice Schakowsky IL
D André Carson IN
D Joe Donnelly IN
D Brad Ellsworth IN
D Baron Hill IN
D Peter Visclosky IN
D Dennis Moore KS
D John Yarmuth KY
D Michael Capuano MA
D William Delahunt MA
D Barney Frank MA
D Edward Markey MA
D James McGovern MA
D Richard Neal MA
D John Olver MA
D John Tierney MA
D Niki Tsongas MA
D Elijah Cummings MD
D Donna Edwards MD
D Steny Hoyer MD
D C. Ruppersberger MD
D John Sarbanes MD
D Chris Van Hollen MD
D Michael Michaud ME
D Chellie Pingree ME
D John Conyers MI
D John Dingell MI
D Dale Kildee MI
D Carolyn Kilpatrick MI
D Sander Levin MI
D Gary Peters MI
D Mark Schauer MI
D Bart Stupak MI
D Keith Ellison MN
D Betty McCollum MN
D James Oberstar MN
D Timothy Walz MN
D Russ Carnahan MO
D Wm. Clay MO
D Emanuel Cleaver MO
D Bennie Thompson MS
D George Butterfield NC
D Bob Etheridge NC
D R. Miller NC
D David Price NC
D Melvin Watt NC
D Earl Pomeroy ND
D Paul Hodes NH
D Carol Shea-Porter NH
D Robert Andrews NJ
D Rush Holt NJ
D Frank Pallone NJ
D Bill Pascrell NJ
D Donald Payne NJ
D Steven Rothman NJ
D Albio Sires NJ
D Martin Heinrich NM
D Ben Luján NM
D Shelley Berkley NV
D Dina Titus NV
D Gary Ackerman NY
D Timothy Bishop NY
D Yvette Clarke NY
D Joseph Crowley NY
D Eliot Engel NY
D John Hall NY
D Brian Higgins NY
D Maurice Hinchey NY
D Steve Israel NY
D Nita Lowey NY
D Daniel Maffei NY
D Carolyn Maloney NY
D Carolyn McCarthy NY
D Gregory Meeks NY
D Scott Murphy NY
D Jerrold Nadler NY
D William Owens NY
D Charles Rangel NY
D José Serrano NY
D Louise Slaughter NY
D Paul Tonko NY
D Edolphus Towns NY
D Nydia Velázquez NY
D Anthony Weiner NY
D John Boccieri OH
D Steve Driehaus OH
D Marcia Fudge OH
D Marcy Kaptur OH
D Mary Jo Kilroy OH
D Dennis Kucinich OH
D Tim Ryan OH
D Betty Sutton OH
D Charles Wilson OH
D Earl Blumenauer OR
D Peter DeFazio OR
D Kurt Schrader OR
D David Wu OR
D Robert Brady PA
D Christopher Carney PA
D Kathleen Dahlkemper PA
D Michael Doyle PA
D Chaka Fattah PA
D Paul Kanjorski PA
D Patrick Murphy PA
D Allyson Schwartz PA
D Joe Sestak PA
D Patrick Kennedy RI
D James Langevin RI
D James Clyburn SC
D John Spratt SC
D Steve Cohen TN
D Jim Cooper TN
D Barton Gordon TN
D Henry Cuellar TX
D Lloyd Doggett TX
D Charles Gonzalez TX
D Al Green TX
D Gene Green TX
D Rubén Hinojosa TX
D Sheila Jackson Lee TX
D Eddie Johnson TX
D Solomon Ortiz TX
D Silvestre Reyes TX
D Ciro Rodriguez TX
D Gerald Connolly VA
D James Moran VA
D Thomas Perriello VA
D Robert Scott VA
D Peter Welch VT
D Brian Baird WA
D Norman Dicks WA
D Jay Inslee WA
D Rick Larsen WA
D Jim McDermott WA
D Adam Smith WA
D Tammy Baldwin WI
D Steve Kagen WI
D Ron Kind WI
D Gwen Moore WI
D David Obey WI
D Alan Mollohan WV
D Nick Rahall WV
No (212)
R Don Young AK
R Robert Aderholt AL
R Spencer Bachus AL
R Jo Bonner AL
D Bobby Bright AL
D Artur Davis AL
R Parker Griffith AL
R Mike Rogers AL
D Robert Berry AR
R John Boozman AR
D Mike Ross AR
R Jeff Flake AZ
R Trent Franks AZ
R John Shadegg AZ
R Brian Bilbray CA
R Mary Bono Mack CA
R Ken Calvert CA
R John Campbell CA
R David Dreier CA
R Elton Gallegly CA
R Walter Herger CA
R Duncan Hunter CA
R Darrell Issa CA
R Jerry Lewis CA
R Daniel Lungren CA
R Kevin McCarthy CA
R Tom McClintock CA
R Howard McKeon CA
R Gary Miller CA
R Devin Nunes CA
R George Radanovich CA
R Dana Rohrabacher CA
R Edward Royce CA
R Mike Coffman CO
R Doug Lamborn CO
R Michael Castle DE
R Gus Bilirakis FL
R Virginia Brown-Waite FL
R Vern Buchanan FL
R Ander Crenshaw FL
R Lincoln Diaz-Balart FL
R Mario Diaz-Balart FL
R Connie Mack FL
R John Mica FL
R Jeff Miller FL
R Bill Posey FL
R Adam Putnam FL
R Thomas Rooney FL
R Ileana Ros-Lehtinen FL
R Clifford Stearns FL
R C. Young FL
D John Barrow GA
R Paul Broun GA
R Nathan Deal GA
R Phil Gingrey GA
R Jack Kingston GA
R John Linder GA
D James Marshall GA
R Tom Price GA
R Lynn Westmoreland GA
R Steve King IA
R Tom Latham IA
D Walter Minnick ID
R Michael Simpson ID
R Judy Biggert IL
R Timothy Johnson IL
R Mark Kirk IL
D Daniel Lipinski IL
R Donald Manzullo IL
R Peter Roskam IL
R Aaron Schock IL
R John Shimkus IL
R Dan Burton IN
R Stephen Buyer IN
R Mike Pence IN
R Mark Souder IN
R Lynn Jenkins KS
R Jerry Moran KS
R Todd Tiahrt KS
D Ben Chandler KY
R Geoff Davis KY
R Brett Guthrie KY
R Harold Rogers KY
R Ed Whitfield KY
R Rodney Alexander LA
R Charles Boustany LA
R Anh Cao LA
R Bill Cassidy LA
R John Fleming LA
D Charles Melancon LA
R Steve Scalise LA
D Stephen Lynch MA
R Roscoe Bartlett MD
D Frank Kratovil MD
R Dave Camp MI
R Vernon Ehlers MI
R Peter Hoekstra MI
R Thaddeus McCotter MI
R Candice Miller MI
R Mike Rogers MI
R Fred Upton MI
R Michele Bachmann MN
R John Kline MN
R Erik Paulsen MN
D Collin Peterson MN
R W. Akin MO
R Roy Blunt MO
R Jo Ann Emerson MO
R Sam Graves MO
R Blaine Luetkemeyer MO
D Ike Skelton MO
D Travis Childers MS
R Gregg Harper MS
D Gene Taylor MS
R Dennis Rehberg MT
R Howard Coble NC
R Virginia Foxx NC
R Walter Jones NC
D Larry Kissell NC
R Patrick McHenry NC
D Mike McIntyre NC
R Sue Myrick NC
D Heath Shuler NC
R Jeff Fortenberry NE
R Adrian Smith NE
R Lee Terry NE
D John Adler NJ
R Rodney Frelinghuysen NJ
R Scott Garrett NJ
R Leonard Lance NJ
R Frank LoBiondo NJ
R Christopher Smith NJ
D Harry Teague NM
R Dean Heller NV
D Michael Arcuri NY
R Peter King NY
R Christopher Lee NY
D Michael McMahon NY
R Steve Austria OH
R John Boehner OH
R Jim Jordan OH
R Steven LaTourette OH
R Robert Latta OH
R Jean Schmidt OH
D Zachary Space OH
R Patrick Tiberi OH
R Michael Turner OH
D Dan Boren OK
R Tom Cole OK
R Mary Fallin OK
R Frank Lucas OK
R John Sullivan OK
R Greg Walden OR
D Jason Altmire PA
R Charles Dent PA
R Jim Gerlach PA
D Tim Holden PA
R Tim Murphy PA
R Joseph Pitts PA
R Todd Platts PA
R Bill Shuster PA
R Glenn Thompson PA
R James Barrett SC
R Henry Brown SC
R Bob Inglis SC
R Joe Wilson SC
D S. Herseth Sandlin SD
R Marsha Blackburn TN
D Lincoln Davis TN
R John Duncan TN
R David Roe TN
D John Tanner TN
R Zach Wamp TN
R Joe Barton TX
R Kevin Brady TX
R Michael Burgess TX
R John Carter TX
R K. Conaway TX
R John Culberson TX
D Thomas Edwards TX
R Louie Gohmert TX
R Kay Granger TX
R Ralph Hall TX
R Jeb Hensarling TX
R Sam Johnson TX
R Kenny Marchant TX
R Michael McCaul TX
R Randy Neugebauer TX
R Pete Olson TX
R Ronald Paul TX
R Ted Poe TX
R Pete Sessions TX
R Lamar Smith TX
R Mac Thornberry TX
R Rob Bishop UT
R Jason Chaffetz UT
D Jim Matheson UT
D Frederick Boucher VA
R Eric Cantor VA
R J. Forbes VA
R Bob Goodlatte VA
D Glenn Nye VA
R Robert Wittman VA
R Frank Wolf VA
R Doc Hastings WA
R C. McMorris Rodgers WA
R David Reichert WA
R Thomas Petri WI
R Paul Ryan WI
R F. Sensenbrenner WI
R Shelley Capito WV
R Cynthia Lummis WY