How did the Affordable Care Act become law in March 2010?

The Patient Protection and Affordable Care Act (ACA) became law in March 2010 through a strategic legislative maneuver led by President Barack Obama, Speaker Nancy Pelosi, and Senate Majority Leader Harry Reid.12

Following the loss of their filibuster-proof majority in the Senate, Democrats bypassed the need for a new compromise bill by having the House of Representatives pass the existing Senate version of the legislation directly. To address concerns from House Democrats regarding abortion funding, President Obama pledged to issue an executive order clarifying that federal funds would not be used for such procedures.12

On March 21, 2010, the House approved the Senate bill, which President Obama signed into law on March 23. Simultaneously, Congress utilized the reconciliation process to pass a secondary "fixes" bill, which addressed specific legislative adjustments and was signed into law on March 30. This process ensured the passage of the most significant U.S. health care reform since the 1965 creation of Medicare and Medicaid.123