page_title: Barack Obama
section_title: Health care reform
hierarchical_section_title: Barack Obama / Presidency (2009–2017) / Domestic policy / Health care reform
caption_attribution_description: English: Barack Obama signing the Patient Protection and Affordable Care Act at the White House Español: Barack Obama firmando la Ley de Protección al Paciente y Cuidado de Salud Asequible en la Casa Blanca
context_page_description: Barack Hussein Obama II is an American politician and attorney who served as the 44th president of the United States from 2009 to 2017. A member of the Democratic Party, Obama was the first African-American president of the United States. He previously served as a U.S. senator from Illinois from 2005 to 2008 and an Illinois state senator from 1997 to 2004.
  Obama was born in Honolulu, Hawaii, making him the first president not born in the contiguous United States. After graduating from Columbia University in 1983, he worked as a community organizer in Chicago. In 1988, he enrolled in Harvard Law School. In 1990, he was elected president of the Harvard Law Review. After graduating, he became a civil rights attorney and an academic, teaching constitutional law at the University of Chicago Law School from 1992 to 2004. Turning to elective politics, he represented the 13th district from 1997 until 2004 in the Illinois Senate, when he ran for the U.S. Senate. Obama received national attention in 2004 with his March Senate primary win, his well-received July Democratic National Convention keynote address, and his landslide November election to the Senate.
context_section_description: Obama called for Congress to pass legislation reforming health care in the United States, a key campaign promise and a top legislative goal. He proposed an expansion of health insurance coverage to cover the uninsured, to cap premium increases, and to allow people to retain their coverage when they leave or change jobs. His proposal was to spend $900 billion over 10 years and include a government insurance plan, also known as the public option, to compete with the corporate insurance sector as a main component to lowering costs and improving quality of health care. It would also make it illegal for insurers to drop sick people or deny them coverage for pre-existing conditions, and require every American to carry health coverage. The plan also includes medical spending cuts and taxes on insurance companies that offer expensive plans.
  On July 14, 2009, House Democratic leaders introduced a 1,017-page plan for overhauling the U.S. health care system, which Obama wanted Congress to approve by the end of 2009. After much public debate during the Congressional summer recess of 2009, Obama delivered a speech to a joint session of Congress on September 9 where he addressed concerns over the proposals. In March 2009, Obama lifted a ban on using federal funds for stem cell research.
  On November 7, 2009, a health care bill featuring the public option was passed in the House. On December 24, 2009, the Senate passed its own bill—without a public option—on a party-line vote of 60–39. On March 21, 2010, the Patient Protection and Affordable Care Act (ACA) passed by the Senate in December was passed in the House by a vote of 219 to 212. Obama signed the bill into law on March 23, 2010.
  The ACA includes health-related provisions, most of which took effect in 2014, including expanding Medicaid eligibility for people making up to 133% of the federal poverty level (FPL) starting in 2014, subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for family of four in 2010) so their maximum "out-of-pocket" payment for annual premiums will be from 2% to 9.5% of income, providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting annual coverage caps, and support for medical research. According to White House and CBO figures, the maximum share of income that enrollees would have to pay would vary depending on their income relative to the federal poverty level.
  The costs of these provisions are offset by taxes, fees, and cost-saving measures, such as new Medicare taxes for those in high-income brackets, taxes on indoor tanning, cuts to the Medicare Advantage program in favor of traditional Medicare, and fees on medical devices and pharmaceutical companies; there is also a tax penalty for those who do not obtain health insurance, unless they are exempt due to low income or other reasons. In March 2010, the CBO estimated that the net effect of both laws will be a reduction in the federal deficit by $143 billion over the first decade.
  The law faced several legal challenges, primarily based on the argument that an individual mandate requiring Americans to buy health insurance was unconstitutional. On June 28, 2012, the Supreme Court ruled by a 5–4 vote in National Federation of Independent Business v. Sebelius that the mandate was constitutional under the U.S. Congress's taxing authority. In Burwell v. Hobby Lobby the Court ruled that "closely-held" for-profit corporations could be exempt on religious grounds under the Religious Freedom Restoration Act from regulations adopted under the ACA that would have required them to pay for insurance that covered certain contraceptives. In June 2015, the Court ruled 6–3 in King v. Burwell that subsidies to help individuals and families purchase health insurance were authorized for those doing so on both the federal exchange and state exchanges, not only those purchasing plans "established by the State," as the statute reads.
caption: Obama signs the Patient Protection and Affordable Care Act at the White House, March 23, 2010.
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