Federal healthcare reform has been an American dream as far back as Theodore Roosevelt's thwarted attempts in 1912. It would take roughly 98 years for the dream to become a reality, but no dream comes without hard work and sacrifice. This is the story of the Affordable Care Act.
November 2008: Running on a message of hope and change, Senator Barack Obama defeats his republican rival, Senator John McCain in a historic election. He promises that healthcare reform will be one of his key legislative goals.
March 2009: President Obama makes good on his vow to the American people by holding an official 'health summit' in Washington. The gathering involves roughly 120 people, representing all facets of the healthcare industry. To get the legislative ball rolling, President Obama appoints Kansas Governor Kathleen Sebelius to run the federal Health and Human Services agency. Shortly after, Congress goes to work undertaking the monumental task of crafting what would later be known as the Affordable Care Act.
July 2009: House Democrats, led by Speaker Nancy Pelosi reveal their massive 1,000-page healthcare reform bill. The bill receives a lukewarm reception from Democrats. Many liberal members of the party disapprove of the exclusion of a 'public option,' which would have created a federal health insurance program. However, to secure the support of the insurance industry and get enough votes to pass, the measure had to be dropped in favor of an individual mandate that would require all Americans to purchase health insurance.
August 2009: Much to the disappointment of the President, the House fails to get a vote before the summer recess. Democrats return to their home states to face hostile public opposition to the new bill. Anger fueled by fear, confusion and misinformation leads to the birth of the conservative Tea Party moment. Republicans recognize the rising tide of anger as an opportunity to take control of the House and begins to focus their efforts on opposing healthcare reform and rallying up conservative support.
November - December 2009: After a bitter November battle, the House manages to pass their bill by a razor thin vote of 220 to 215. After a month of wrangling and revisions, the Senate passes their version of the Affordable Care Act, narrowly escaping a GOP filibuster. The bill passes along party lines, 60 to 39 during a rare Christmas Eve vote. The House and the Senate begin negotiations to reconcile the differences between their two bills.
January 2010: Republican opposition efforts prove fruitful during an epic battle for late Massachusetts Senator Ted Kennedy's seat. Democratic candidate Martha Coakely loses to Republican Scott Brown, throwing the future of the Affordable Care Act into question. On the night of the election, President Obama holds an emergency meeting with congressional Democrats regarding the future of healthcare reform. Nancy Pelosi assures the President that she can still get the job done. The revised Affordable Care Act passes the house 219 to 212, without a single Republican vote.
March 23, 2010: Two days after passing through the House, President Obama signs the Affordable Care Act into law, finally realizing the 98-year-old dream.
January 2011: A Florida judge rules some provisions of the new law as unconstitutional, once again throwing the future of the Affordable Care Act into question. This marks the beginning of a series of court fights that would eventually end up in the hands of the Supreme Court.
June 28, 2012: In a surprise landmark ruling, the Supreme Court upholds most of the provisions of the Affordable Care Act. The law would be preserved for now, but Republicans and the Tea Party still had their sights set on its destruction. They had successfully rode the wave of vitriol towards 'ObamaCare' into power in the House of Representatives. There next goal: to win control of the White House.
November 6, 2012: President Obama is re-elected in a narrow win against Republican challenger Mitt Romney. An election that secured his presidency and the continued survival of the Affordable Care Act.
December 2012: As implementation of the Affordable Care Act continues, so does Republican opposition. Only 17 states and the District of Columbia agree to run their own healthcare exchanges, leaving the federal government with the monumental task of managing the exchange for 33 states. This is a burden far greater than the department of Health and Human Services had anticipated.
October 1, 2013: After several delays and adjustments in policy, HealthCare.gov officially launces and people begin shopping for insurance on the federal and state exchanges. Unfortunately, the federal website is riddled with technical issues. Soon, the glitches and frequent crashes at HealthCare.gov dominate the news cycle, often overshadowing the exchange's successes. On the very same day, the congressional Republican's efforts to defund the Affordable Care Act eventually lead to a 16-day government shutdown.
October 30, 2013: After several weeks of continuing technical problems, Kathleen Sebelius formally takes responsibility for the issues surrounding the rollout of the public healthcare exchange. She assures the public that the website wasn't hacked and that it will be running smoothly by the end of November.
April 2014: By the end of the first enrollment period, over 8-million Americans had enrolled in a marketplace plan under the Affordable Care Act. New enrollees weren't the only ones who benefited from the law however; many young adults were allowed to stay on their parent's insurance, millions of Americans were helped by the Medicaid expansion, and new requirements on employers meant more workers also got insured. In all, nearly 15-million people were able to get insurance under the new law.
The signing of the Affordable Care Act marked the realization of a 98-year-old American dream. However, this dream is no fairy tale and continuing legal challenges and conservative opposition means that the story of healthcare reform is still far from over. The whims of the courts and the will of the voters will ultimately decide the next chapter of this ever flowing saga of American history.