The Health Care and Education Reconciliation Act of 2010 (, ) was enacted by the 111th United States Congress, by means of the budget reconciliation process, in order to amend and extend the recently passed legislation expanding healthcare access known as the Affordable Care Act (ACA)() (together, the bills implemented a healthcare reform that became known as "Obamacare").
The reconciliation also included the Student Aid and Fiscal Responsibility Act of 2009, which was attached as a rider: this pairing allowed Democrats to achieve reforms to student loans programs, but critically it also provided budget savings sufficient to offset the ACA's dramatically increased investment in healthcare; which in turn meant that the reform bills could be progressed and passed through the Senate using the budget reconciliation procedures, avoiding threatened Republican filibusters that otherwise would derail what were two of the major domestic policy reform priorities of the new President Obama.
The large and complex reconciliation bill was passed by the U.S. House of Representatives on March 21, 2010, by a vote of 220âÂÂ211, and passed the Senate by a vote of 56âÂÂ43 on March 25, after having had two minor provisions (relating to Pell Grants) stricken under the Byrd Rule. A few hours later the bill, as amended, was passed in the House by a vote of 220âÂÂ207. The Act was signed into law by President Barack Obama on March 30, 2010, at Northern Virginia Community College.
At the end of 2009, each house of Congress passed its own health care reform bill, but neither passed the bill from the other chamber. The Senate bill, the Patient Protection and Affordable Care Act, was less ambitious overall than the House's attempt: Democrats controlled the House, which was as a consequence of the election more progressive than the Senate. And the need for significant systematic healthcare reform was understood and acknowledged popularly, including by the President, who had determined healthcare would be the major reform push of his early presidency. Democrats' more extensive proposed reforms, however, would not easily pass the Senate, where they had a majority but less than the de facto majority requirement of 60 (of 100 total senators). Taking up the Senate's already passed, if relatively unambitious, bill was therefore the most viable avenue to the achievement of reforms; this was especially true following the death of Democratic Senator Ted Kennedy and his replacement by Republican Scott Brown. Lacking a filibuster-proof super-majority in the Senate, the Obama administration and House Speaker Nancy Pelosi encouraged the House to pass the Senate bill, building that as a foundation, and then come back to pass another, new bill â to amend and extend and fund what had been done by the Senate-drafted ACA â using the budget reconciliation process.
Under the Fiscal Year 2010 budget resolution, the text of the reconciliation bill submitted to the Budget Committee had to have been reported by the relevant Committees by October 15, 2009. Therefore, the Democrats combined the text of America's Affordable Health Choices Act of 2009 as reported out of the Ways and Means Committee, and as it was reported out of the Education and Labor Committee, and the text of the Student Aid and Fiscal Responsibility Act as reported out of the Education and Labor Committee. This version was never meant to be passed; it was only created so that the reconciliation bill would comply with the Budget resolution. The bill was automatically amended to the version that was meant to be passed per the special rule that was reported out of the Rules Committee. The Student Aid and Fiscal Responsibility Act was added to the Reconciliation Act as only one reconciliation bill can be passed each budget year, and it also faced a tough road through the Senate due to Republican filibuster and opposition from several centrist Democratic Senators. The move was also thought to give President Obama two key victories in overhauling the health care and student loan system. It also eventually became clear that the budget savings caused by the student loan bill would become essential to the overall reconciliation bill by reducing the deficit enough for the overall bill to qualify for the reconciliation process.
Passage of the legislation in the United States House of Representatives using the self-executing rule method was considered, but rejected by House Democrats. Instead, on March 21, 2010, the House held a series of votes: the first vote on ordering the previous question on the special rule resolution that set the terms of debate, the second on the rule itself, the third on the Senate bill, the fourth on a minority attempt to amend the reconciliation bill itself, and finally a vote on the reconciliation bill itself. The reconciliation bill passed on a vote of 220âÂÂ211, with all 178 Republicans and 33 Democrats voting against it.
In the Senate, the bill faced numerous amendments made by the Republicans, which failed. Republicans struck two provisions dealing with Pell Grants from the bill due to violations of budget reconciliation rules, forcing the bill to return to the House. The two provisions were the fourth paragraph of Sec. 2101(a)(2)(C) and Sec. 2101(a)(2)(D). On March 25, the bill passed the Senate by a 56âÂÂ43 vote, with all Republicans and three Democrats (Blanche Lincoln (D-AR), Ben Nelson (D-NE) and Mark Pryor (D-AR)) voting against it. Later that same day, the House passed the amended bill by a 220âÂÂ207 vote, sending it to President Obama for a signature. On March 30, 2010 Obama signed the Health Care and Education Reconciliation Act of 2010, seven days after he had signed the Patient Protection and Affordable Care Act into law.
The Health Care and Education Reconciliation Act is divided into two titles, one addressing health care reform and the other addressing student loan reform.
The Reconciliation bill made several changes to the Affordable Care Act that was signed into law seven days earlier on March 23, 2010. These changes include the following:
Title II of the reconciliation bill deals with student loan reform. The language is very similar to the Student Aid and Fiscal Responsibility Act that passed the House in 2009; but with some slight variation. The reform package included,
The law codified the "economic substance" rule of Gregory v. Helvering from 1935, which allows the IRS to invalidate tax avoidance transactions in certain situations.
The Congressional Budget Office's last estimate predicted that if both bills were passed into law in 2010, the net reduction in federal deficits would be $143 billion over the 2010âÂÂ2019 period as a result of the proposed changes in direct spending and revenues. That figure comprises $124 billion in net reductions deriving from the health care and revenue provisions and $19 billion in net reductions deriving from the education provisions. The health care and revenue provisions consist in part of several new taxes, fees on health-related industries, and cuts in government spending on healthcare programs like Medicare Advantage.