美国《患者保护和负担得起的护理法》 [2010]

最终通过

但是，立法的命运尚不确定，因为参议院和众议院之间存在相当大的分歧，必须加以调和。使事情复杂化的是马萨诸塞州斯科特·布朗（Scott Brown）参议院的选举，该人填补了特德·肯尼迪（Ted Kennedy）死后民主党人保罗·柯克（Paul Kirk）临时占据的席位。积极反对卫生法案的布朗当选，剥夺了民主党人的抵制垃圾邮件的多数，并使最终通过的前景不确定。

2010年3月，就在历史性措施濒临失败的边缘之际，奥巴马和民主党领导人，特别是参议院多数党领袖哈里·里德（Harry Reid）和众议院南希·佩洛西（Nancy Pelosi）的发言人，发起了最后一波竞选活动，随后进行了立法调整。面对医疗改革失败的前景，民主党最终决定采取一项战略，众议院将通过参议院版本的法案，使其成为法律，然后立即通过一项法案修正案（“确定”），提交参议院的法律。由于Stupak和一群支持生命的民主党人反对参议院关于堕胎的措辞，堕胎再次威胁到立法的失败。但是，奥巴马通过承诺发布行政命令进行澄清，以澄清联邦资金不能用于堕胎。Stupak和其他218名民主党人于3月21日在参议院内部和外部经常加热的气氛中最终批准了该法案的参议院版本。包括曹在内的所有共和党人都反对参议院的法案。一揽子“修正案”随后通过了众议院220-211法案，随后获得参议院和众议院的批准，因为与学生贷款有关的规定被剥夺为违反规定的行为。奥巴马于3月23日签署了《平价医疗法案》，并于3月30日签署了修正法案。一揽子“修正案”随后通过了众议院220-211法案，随后获得参议院和众议院的批准，因为与学生贷款有关的规定被剥夺为违反规定的行为。奥巴马于3月23日签署了《平价医疗法案》，并于3月30日签署了修正法案。一揽子“修正案”随后通过了众议院220-211法案，随后获得参议院和众议院的批准，因为与学生贷款有关的规定被剥夺为违反规定的行为。奥巴马于3月23日签署了《平价医疗法案》，并于3月30日签署了修正法案。

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Following the 2010 midterm elections, the Republicans—who had pledged during the campaign to repeal the health care bill—gained control of the House of Representatives. In one of their first acts, the House Republicans, with three Democrats, voted in January 2011 to repeal the legislation, 245–189. The following month, however, the repeal failed in the Democrat-controlled Senate on a party-line vote.

The Affordable Care Act was also challenged by the attorneys general in more than a dozen states who filed suit, charging that the reform, in particular the individual mandate (the requirement that most Americans carry health insurance by 2014 or pay a penalty), was unconstitutional. Although a number of lawsuits were dismissed, some federal judges ruled beginning in late 2010 that Congress had, by enacting the individual mandate (due to take effect in 2014), exceeded the authority granted it by the commerce clause and the general welfare clause. None of these judges, however, halted the implementation of the law while the administration appealed. In March 2012 the U.S. Supreme Court heard challenges to the Affordable Care Act in the Affordable Care Act cases. In its ruling, issued in June 2012, the court held (5–4) that the individual mandate was constitutional under Congress’s taxing power and that the law’s expansion of Medicaid—the national health-insurance program for the poor, jointly funded by the federal government and the states—was constitutional as long as states that refused to expand their Medicaid rolls did not lose federal Medicaid funding for existing beneficiaries.