The ACA almost didn't make. We had just lost Ted Kennedy, and Massachucets just elected Scott Brown
Brown to replace him. That we were able to actual healthcare passed is nothing short of extraordinary, and it almost didn't happen:
"There is no doubt that the president made healthcare reform a top early priority. There was good reason for doing so; past experience, including that of the Clinton health-reform plan, showed that waiting to pass a major social-policy change, in the absence of a great crisis, is a fool’s errand. A president’s momentum, his public support, and the backing of his party peak early, and major social-policy change by definition shakes up the status quo, creating losers along with potential winners and an even larger number of those unsettled by change. The longer presidents wait, the greater the likelihood that their opposition will mobilize and exploit uneasy voters. And the closer midterm elections loom, the more nervousness builds among lawmakers from the president’s party.
So to accomplish a goal that had eluded a slew of previous presidents, it was necessary to start early. But it is also the case that the White House and Democrats in Congress did not lead with healthcare reform. They began, instead, with a series of actions aimed at the broken economy, including the auto bailout and the major stimulus package, which included a series of programs to help financially strapped Americans, and to get more back to work.
We know that congressional Republicans pursued a conscious strategy not to cooperate with Democrats on the stimulus, voting in unison in the House against it. Very early on, Dave Obey, then chairman of the House Appropriations Committee, asked his counterpart on the committee, Republican Jerry Lewis, to get his leaders and rank-and-file to provide Republican ideas to include, and non-starters to exclude, in a stimulus plan and was told that there were orders from “on high” not to cooperate. But despite that, the stimulus package was adopted over a Senate GOP filibuster before a healthcare reform effort moved into full bloom. Could the stimulus have done more to create jobs in the short term? Certainly—but in part to accommodate Senate Republicans like Charles Grassley, who nonetheless ended up voting against the bill, 40 percent of the stimulus package was tax cuts that mostly did little either to add jobs or stimulate the economy."
https://www.theatlantic.com/politics/archive/2015/07/the-real-story-of-obamacares-birth/397742/
