The ACA would have been more like the House version, but because we lost the filibuster majority
in the Senate in 2010, the House had to accept the Senate version, or have no healthcare legislation.
In 2008, the Democrats safely controlled the House
"Going into the 2008 election, the Senate on consisted of 49 Democrats and 49 republicans, with two independents, Joe Lieberman and Bernie Sanders, who both caucused with the Democrats, which gave the Democrats the majority in the Senate.
After the 2008 election the Democrats picked up 8 seats to increase their majority to 57-41, though Al Franken's recount victory was not official until July 7. With the two independents, the Democrats were one vote shy of the supermajority magic number of 60 they needed to ward off any filibuster attempts.
But on April 28, 2009, the dynamics changed when Pennsylvania Republican Arlen Spector changed parties, giving Senate Democrats that coveted 60th vote.
Now the Democrats had a safe majority in the House and a filibuster-proof supermajority of 60 in the Senate. That scenario lasted only four months before fate intervened. Sen. Ted Kennedy of Massachusetts died on August 25, 2009, leaving the Democrats, once again, with 59 seats (counting the two Independents). Exactly one month later, on September 25, Democrat Paul Kirk was appointed interim senator from Massachusetts to serve until the special election set for January 19, 2010 – once again giving the Democrats that 60th vote. But the intrigue was just beginning.
There didn’t seem to be an urgent need for Democrats to reconcile both bills immediately, because the Massachusetts special election (scheduled for January 19, 2010) was almost certain to fall to the Democrat, Attorney General Martha Coakley. After all, no Republican had been elected to the U.S. Senate from the Bay State since Edward Brooke in 1972 – 38 years before! But in yet another twist of fate, Republican Scott Brown ran his campaign as the 41st senator against ObamaCare and shocked nearly everyone by winning the special election by 110,000 votes.
That left House Speaker Nancy Pelosi and President Obama in a dilemma. Everyone assumed that the Christmas Eve 2009 Senate bill would be tweaked considerably to conform more with the House bill passed two months previously. But now that strategy wouldn’t work, because the Democrats no longer had the 60th vote in the Senate to end debate. What to do? They decided to have the House take up the identical bill that the Senate passed on Christmas Eve. It passed on March 21, 2010, by a 219 – 212 vote. This time, no Republicans came on board, and 34 Democrats voted against. President Obama signed the ACA legislation two days later on March 23.
https://www.forbes.com/sites/physiciansfoundation/2014/03/26/a-look-back-at-how-the-president-was-able-to-sign-obamacare-into-law-four-years-ago/#45e2af2a526b
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