The health care reform bill before the Supreme Court first took shape as President Obama’s campaign promise when he was running for the White House in 2008.
In fact, Obama’s was just one of several reform proposals by the top presidential candidates – including GOP nominee Sen. John McCain with his open-market plan, and Democratic candidate Hillary Clinton, who proposed a plan more comprehensive than Obama’s before quitting the race in June 2008.
Charged with fulfilling the president’s plan to essentially insure every American, the Democrat-controlled 111th Congress devoted much of its energy toward crafting comprehensive reform legislation.
The president’s so-called National Health Insurance Exchange included private insurance plans and a government-run option.
“If you like your insurance, you can keep it,” was Obama’s oft-repeated phrase.
The House was the first chamber to take up and pass the legislation, passing the Affordable Health Care for America Act, or House Resolution 3962, in November 2009.
On December 24, 2009, the Senate passed its Patient Protection and Affordable Care Act -- a modified version of HR 3590.
The vote was 60 to 39, with all Democrats and two independents voting in favor. Every Republican voted against the legislation except Sen. Jim Bunning, R-Ky., who did not vote.
The Senate has to work from a House resolution because revenue-related bills must begin in the lower chamber.
Democrats were concerned about losing their 60-seat filibuster-proof supermajority after the death of Sen. Edward Kennedy, D-Mass., and a leader in health care reform.
After the House and Senate conferees agreed on the bill, the legislation returned to the Senate.
By then, Republican Scott Brown had already taken Kennedy’s seat in a special election, in part on his promise to be the deciding vote against so-called ObamaCare.
However, Majority Leader Harry Reid used a parliamentary tactic known as “reconciliation” that required only 51 votes for passage.
The legislation passed the Senate in March 2010, then was signed by the president.
The law requires that essentially every American have health insurance or pay a fine. It also expanded insurance for 30 million Americans and increased coverage for pre-existing conditions.
The law drew an immediate and sharp response from the Tea Party movement and similar groups advocating for less government.
It also resulted in several states, which were forced to established health care exchanges, to challenge the constitutionality of the law.
Before the law reached the Supreme Court, two federal appeals courts upheld it; another declared the individual mandate unconstitutional and the fourth essentially said no ruling could be made until taxpayers started paying the penalties in 2015.
The Supreme Court agreed to take up the case in November 2011 and heard oral arguments in March 2011 before making the decision Thursday.