How Health Care Reform Survived

If Republicans don’t take the White House in November, the health care reform saga is over (and it might be over even if they do). The Affordable Care Act passed, is being implemented, and its biggest mortal threat — the Supreme Court — upheld the law on Thursday, with the support of conservative Chief Justice John Roberts.

But getting here was extraordinarily tumultuous. These seven stories distill the three-year saga:1). Public Option Dies

Dems had to go it alone on health care reform. Republicans were never interested in earnestly participating. That meant infighting, particularly over the public option. In the end, conservative Democrats prevailed in a fight with progressives and stripped the public option from the Senate’s health care bill. They also opposed all similar measures, and threw the whole legislative project into doubt.

2). Dems Lose Their 60th Vote

By the end of 2009, Senate Dems had gotten their act together enough to pass a public-option free health care bill. But before it could be reconciled with the more progressive House legislation, Senate Dems lost their filibuster-proof 60-vote majority in the Massachusetts special election for the late Ted Kennedy’s Senate seat — a bitter irony considering Kennedy’s own pivotal decades-long role in agitating for reform. It appeared the year-long effort was doomed.

3). Health Care Reform Passes

Ultimately, Democrats figured out a way forward. It required House Democrats to hold their noses and pass the Senate bill they hated in exchange for a promise that Senate Dems would streamline major amendments to its key measures. Dems were able to use the budget process aggressively to pass that side-car, avoiding a filibuster. It was complicated and contentious, but they did it.

4). Legal Jeopardy

Immediately after the bill became law, it faced myriad legal challenges, most based on the theory that its individual mandate exceeded the Commerce Clause powers given to Congress in the Constitution. Most legal experts laughed off the challenges. But conservatives undertook an enormous effort to legitimize the arguments. When Republican-appointed judges started ruling that the law violated the Constitution, people started taking notice.

5). What If It Falls?

At some point, the idea that the Supreme Court might ultimately throw the entire law out the window began to take hold. That meant asking, What happens to the people who actually rely on the its existing benefits?

6). Tip Of The Hand

Oral arguments before the Supreme Court racked reformers nerves. Conservative justices seemed incredibly hostile to the law, and the Obama administration’s lawyer, Solicitor General Donald Verrilli, didn’t acquit himself very well. But Justice John Roberts provided a subtle hint that he might be sympathetic to one of the respondents’ argument.

7. It Stands

Well, you know the rest.