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111th Congress, Vote 396; Senate #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 Senate December 24, 2009, 60-39, 1 not voting.

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."
12/24/2009 Status: Senate bill passed

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

Yes (60)
Our pick
D Mark Begich AK
D Blanche Lincoln AR
D Mark Pryor AR
D Barbara Boxer CA
D Dianne Feinstein CA
D Michael Bennet CO
D Mark Udall CO
D Christopher Dodd CT
I Joseph Lieberman CT
D Thomas Carper DE
D Edward Kaufman DE
D Bill Nelson FL
D Daniel Akaka HI
D Daniel Inouye HI
D Thomas Harkin IA
D Roland Burris IL
D Richard Durbin IL
D Evan Bayh IN
D Mary Landrieu LA
D John Kerry MA
D Paul Kirk MA
D Benjamin Cardin MD
D Barbara Mikulski MD
D Carl Levin MI
D Debbie Stabenow MI
D Alan Franken MN
D Amy Klobuchar MN
D Claire McCaskill MO
D Max Baucus MT
D Jon Tester MT
D Kay Hagan NC
D Kent Conrad ND
D Byron Dorgan ND
D Ben Nelson NE
D Jeanne Shaheen NH
D Frank Lautenberg NJ
D Robert Menendez NJ
D Jeff Bingaman NM
D Tom Udall NM
D Harry Reid NV
D Kirsten Gillibrand NY
D Charles Schumer NY
D Sherrod Brown OH
D Jeff Merkley OR
D Ron Wyden OR
D Robert Casey PA
D Arlen Specter PA
D John Reed RI
D Sheldon Whitehouse RI
D Tim Johnson SD
D Mark Warner VA
D Jim Webb VA
D Patrick Leahy VT
I Bernard Sanders VT
D Maria Cantwell WA
D Patty Murray WA
D Russell Feingold WI
D Herbert Kohl WI
D Robert Byrd WV
D John Rockefeller WV
No (39)
R Lisa Murkowski AK
R Jefferson Sessions AL
R Richard Shelby AL
R Jon Kyl AZ
R John McCain AZ
R George LeMieux FL
R Saxby Chambliss GA
R John Isakson GA
R Charles Grassley IA
R Michael Crapo ID
R James Risch ID
R Richard Lugar IN
R Samuel Brownback KS
R Pat Roberts KS
R Mitch McConnell KY
R David Vitter LA
R Susan Collins ME
R Olympia Snowe ME
R Christopher Bond MO
R Thad Cochran MS
R Roger Wicker MS
R Richard Burr NC
R Mike Johanns NE
R Judd Gregg NH
R John Ensign NV
R George Voinovich OH
R Thomas Coburn OK
R James Inhofe OK
R Jim DeMint SC
R Lindsey Graham SC
R John Thune SD
R Lamar Alexander TN
R Bob Corker TN
R John Cornyn TX
R Kay Hutchison TX
R Robert Bennett UT
R Orrin Hatch UT
R John Barrasso WY
R Michael Enzi WY
Not Voting (1)
R Jim Bunning KY