Affordable Care Act: Then and Now

On health care reform, the American people are too often offered two extremes—government-run health care with higher taxes, or letting the insurance companies operate without rules. I believe both of these extremes are wrong.” –Barack Obama, one week prior to Election Day ’08.

From its earliest beginnings through the present, the Affordable Care Act, commonly referred to as “Obamacare,” has experienced a noteworthy journey.

As a new president, Obama’s first step toward a new and revised national health insurance plan was the convening of a health summit between doctors, insurance companies, drug companies, consumer advocates and lawmakers.

“The status quo is the one option that is not on the table,” said President Obama. Clearly, the winds of change had begun to blow.

From its earliest beginnings through present day, here is a condensed history of the Affordable Care Act:

    • MARCH 2009: President Obama appoints our very own Kansas governor, Kathleen Sebelius, who has shown that she is willing to take on the insurance industry, as head of Health and Human Services. She also heads the White House Office for Health Reform.
    • JULY 2009: Democrats in the House reveal their 1,000 page plan for health care overhaul. President Obama’s ally and House Speaker Nancy Pelosi states: “When I take this bill to the floor, it will win.” The various committees of the House begin voting on provisions and closely examining the details.
    • AUGUST 2009: Many lawmakers return to their home states to find much concern and worry over “Obamacare.”
      “Americans are shell-shocked by the many changes in the first eight months in Obama’s administration,” one lawmaker states.
    • NOVEMBER 7th 2009: By a 220-215 vote, the House approves its version of health care reform. Only one Republican voted in favor.
    • DECEMBER 24th, 2009: Majority agreement in both chambers of Congress, with the Senate approving its overhauled version in a 60-39 vote.
    • JANUARY 2010: In President Obama’s first State of the Union address, he assures Americans that the health care overhaul will “protect every American from the worst practices of the insurance industry.”
    • FEBRUARY 2010: President Obama calls a bipartisan health care meeting for both Democrat and Republican leaders, stating “the Democratic and Republican approaches to health care have more in common than most people think.” Also, Anthem Blue Cross of California informs many of their members that their premiums will increase by 39%. As the White House and Congress investigate this announcement, Democrats increase their resolve to bring about positive change.
    • MARCH 21ST 2010: The House okays the Senate’s plan in a 219-212 vote. All Republicans voted against it.
    • MARCH 23RD 2010: President Obama signs the Affordable Care Act into law. “We did not fear our future. We changed it.” Millions of uninsured Americans will now be insured through the insurance marketplace—called exchanges—and Medicaid coverage is expanded.
    • SPRING 2010: Kansas’ own Kathleen Sebelius is appointed to the newly created office to build the insurance exchanges as a function of the Health and Human Services department she manages.
    • JUNE 2010: The first major provisions of the Affordable Care Act go into effect. Adults with pre-existing conditions can join temporary high-risk pools.
    • JULY 2010: launches. The enrollment function is not yet added.
    • SEPTEMBER 23RD, 2010: More provisions go in to effect:
      *dependent children can remain on their parent’s policies until age 26
      *no lifetime limits on coverage
      *no pre-existing exclusions for those under age 19
      *insurers are barred from requiring co-payments for preventive care and
    • JANUARY/FEBRUARY 2011: The Centers for Medicare and Medicaid—CMS—take over responsibility for building the insurance marketplace.
    • SEPTEMBER 2011: Health insurance companies must disclose any rate increase greater than 10% to the general public.
    • NOVEMBER 14TH 2011: The Supreme Court hears arguments against Obamacare brought by 26 states and the National Federation of Independent Business, arguing that some elements are unconstitutional.
    • JUNE 28TH, 2012: The Supreme Court upholds the constitutionality of
      the major provisions of the Affordable Care Act.
    • OCTOBER 1ST, 2013: Health Insurance Exchanges are scheduled to open, with the policies going into effect January 1st, 2014. The site crashes after a relatively small number of shoppers attempt to create accounts.
    • JANUARY 1ST, 2014: Most of the components of the Affordable Care Act go into effect, including:
      *prohibition of denial of coverage to adults with pre-existing conditions
      *large employers are required to provide coverage to those who work at
      least 30 hours/week
      *small businesses that provide coverage are given tax breaks
    • NOVEMBER 2016: Donald Trump is elected president, with a major campaign promise to “repeal and replace” the Affordable Care Act.
    • MARCH 2017: “Obamacare is the law of the land,” says a defeated and disappointed Paul Ryan. GOP leaders failed to win over Republican conservatives and moderates, and they accept defeat of their proposed American Health Care Act. The Affordable Care Act lives on.


With an eye to the future, the following provisions are set to become part of the Affordable Care Act:

    • JANUARY 2018: All existing health insurance plans must cover preventive care and checkups without copays.
    • JANUARY 2020: The Medicare Part D donut hole coverage gap will be phased out.

From its beginnings with President Obama’s early presidency through the present and likely the future, the Affordable Care Act is now widely regarded as the most sweeping health care reform in decades, and appears to be here to stay.