ABC News(WASHINGTON) — The latest push to overhaul the U.S. health care system cleared a significant hurdle last week when the Republican-controlled House approved the American Health Care Act, but there are many more to come.
Here is a look at its rollout, compared to the various steps that the Obama administration took to get the Affordable Care Act (ACA) signed into law in 2010.
’Obamacare’ passage
Jan. 24, 2009: Then-President Barack Obama launched what would become more than a year of testy negotiations, making his intention to focus on health care clear in his address to Congress just over a month after his inauguration.
June 24, 2009: Obama fields questions about his plans for health care overhaul during an ABC News forum at the White House. This was one example of ways that Obama actively campaigned for the overhaul effort.
July 15, 2009: The Senate passed the Affordable Health Choices Act.
Nov. 7, 2009: The House of Representatives passed the Affordable Care Act with a 220-215 vote. It was then sent to the Senate, which had been working on its own amendments to the bill, and dealing with a shifting headcount that came after Sen. Al Franken, D-Minn., was elected in a special election in Minnesota and longtime Sen. Ted Kennedy, D-Mass., died in August.
Dec. 24, 2009: The Senate passed its similar but not identical version of the Affordable Care Act by a 60-39 vote, with all the Senate Democrats voting for it along with two independents and no Republicans, according to The Hill.
Jan. 19, 2010: There’s an upset in the Massachusetts special election, with a victorious Scott Brown going on to fill Kennedy’s vacant Senate seat, flipping the seat from Democratic to Republican and giving Republicans the vote they needed to sustain a filibuster in the Senate.
March 11, 2010: Then-Senate Majority Leader Harry Reid says Democrats will use reconciliation so they only need 51 votes to pass, not 60. In a letter to Senate Minority Leader Mitch McConnell, the Democrats explained that, “Reid said he will seek a democratic, up-or-down simple majority vote to revise the health reform bill already passed by a supermajority of 60 Senators last December.”
March 21, 2010: The House took a version of the ACA that the Senate passed in December and passed it with a vote of 219-212, with all Republicans and 33 Democrats voting against it.
March 23, 2010: Obama signs the Patient Protection and Affordable Care Act into law. Republicans introduced a bill to repeal the law the day after it was signed, and have tried similar moves more than 60 times since.
March 25, 2010: The Senate passed The Health Care and Education Reconciliation Act by reconciliation, with a vote of 56-43. Later that day, the House passed this modified bill by a 220-207 vote.
March 30, 2010: The Health Care and Education Reconciliation Act was signed into law by Obama.
Trump’s health care push
Trump called for the Affordable Care Act, Obama’s landmark health care legislation, to be repealed and replaced throughout the campaign and carried that concept through his transition but began to suggest that the sweeping changes he proposed may not affect every part of the law.
Throughout the campaign, he had regularly called for an “immediate” effort to “repeal and replace” Obamacare.
March 6, 2017: House Republicans unveiled the American Health Care Act and were met with criticism from some conservative groups who complained that it fell short of a campaign pledge to repeal and replace Obamacare, while liberals blasted it as potentially leaving too many people uninsured.
March 7, 2017: The day after the bill was introduced, House Freedom Caucus member Rep. Jim Jordan, R-Ohio, slammed the bill as “Obamacare in a different form.”
House Speaker Paul Ryan, House Majority Leader Kevin McCarthy and Health and Human Services Secretary Tom Price worked to defend the bill, with Speaker Ryan even holding a PowerPoint presentation to explain the AHCA.
March 13, 2017: The Congressional Budget Committee released its report estimating that about 14 million more people would be uninsured next year if the original AHCA were enacted. In the next nine years or so, the number of uninsured would jump to 24 million more, according to the CBO.
After the release of the CBO report, several moderate House Republicans announced opposition to the bill because of the increase in Americans without health care coverage.
Despite the CBO report, the bill seemed to be on course as it cleared two hurdles, moving forward with approval from the Ways and Means Committee and the House Budget Committee.
March 20, 2017: A number of tweaks were made to the original legislation in an effort to muster votes. The amendments included changes to Medicaid funding, an optional work requirement for Medicaid and instructions for the Senate to construct a $75 billion fund that would provide additional tax credits to help people buy insurance.
March 24, 2017: At Trump’s request, House Speaker Paul Ryan pulled the American Health Care Act (AHCA) off the floor moments before a scheduled vote.
Divisions within the Republican Party ultimately led to the bill’s being yanked as lawmakers failed wrangle enough votes on their side of the aisle for passage in the House. Members of the conservative House Freedom Caucus, along with a few moderate Republican lawmakers, planned on opposing the bill if it went to a vote.
“Obamacare is the law of the land… and we’re going to be living with Obamacare for the foreseeable future,” Ryan conceded a short time after the bill was dropped.
A spokesman for Ryan released a statement March 26 making it clear that the intention is to move on.
“The speaker and president talked for an hour yesterday about moving forward on the agenda and their relationship is stronger than ever right now,” the spokesman said.
May 4, 2017: Republicans in the House of Representatives passed what they said was their plan to repeal and replace Obamacare, after several fits and starts, sending the measure to the Senate, where it is expected to be significantly revised.
The bill passed the House in a narrow 217-213 vote. All Democrats opposed the bill.
At a celebratory news conference in the White House’s Rose Garden, Trump congratulated House Speaker Paul Ryan and praised House Republicans for coming together.
“What we have is something very, very incredibly well-crafted,” Trump said of the bill.
“As much as we’ve come up with a really incredible health care plan, this has brought the Republican Party together. We’re going to get this finished.”
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