Summary Overview

When President Barack Obama proposed health care reform in February 2010, its future was uncertain. Speaker of the U.S. House of Representatives, Nancy Pelosi was one of the individuals charged with trying to shepherd passage of the bill, known as the Affordable Care Act (ACA; also called “Obamacare”). Thus, her speech on the floor of the House of Representatives, given the day of the vote, was a forceful statement of the goals that the president, the Democratic Party, and she had for access to health care in the United States.

As leader of the Democrats in the House, Pelosi needed to keep the party members relatively unified in support of the bill. While many wavered in their support (34 Democrats voted against it) she was able to persuade a few who had been on the fence and to give them political cover by making herself the target of any anti-ACA sentiment. When enacted, this new law became one of the nation’s landmarks in health care policy.

Defining Moment

Although the presidential election of 1912 saw former President Theodore Roosevelt’s Progressive Party include a proposal for the federal government’s involvement with health insurance, his campaign and the proposal were not successful. However, at some point during each of the following decades, bills were introduced to implement various aspects of government supported health care or insurance. Even while President Franklin Roosevelt was successful in passing many pieces of social welfare legislation, his health care bill was defeated. Only President Lyndon Johnson was able to make a significant stride forward, with the adoption of Medicare and Medicaid programs. Health care became a more significant issue at the end of the twentieth and start of the twenty-first centuries. However, it came to be a partisan issue, with Democrats more likely to support government involvement in providing health care insurance and Republicans likely to oppose it.

The 2008 election created a real opportunity for the adoption of health care legislation, with the Democrats as the majority party in the House and the Senate, and with Democratic candidate Barack Obama winning the presidency. Thus, 2009 saw several proposals put forward by the president and various members of the U.S. Congress without any one proposal passing both houses. By December 2009, two versions of the same bill passed both houses, which meant that this time it would go to a joint House-Senate conference committee. Nevertheless, a special Senate election in January 2010 turned out to be a loss for the Democrats, meaning that they could no longer block a Republican filibuster. Thus, if health care reform were to pass, it would be up to Speaker Nancy Pelosi, with assistance from President Obama, to get most Democratic members of the House to accept the Senate version of the bill, so that no further action would be required by the Senate (and spark a likely filibuster). Most of Pelosi’s efforts took place behind the scenes, including crafting a companion bill to take up some of the perceived deficiencies of the Affordable Care Act (ACA). But Pelosi was an outspoken advocate for the bill, publicly and behind closed doors. The transcription of her speech given here, delivered the day of the final vote in the House, was a strong statement of her support for health care reform, and particularly the ACA.

Author Biography

Nancy D’Alesandro (b. 1940) was born in Baltimore, Maryland. Her father served as mayor of Baltimore and a member of Congress. Nancy graduated from Trinity College, marrying Paul Pelosi, with whom she had five children. They moved to his hometown of San Francisco. After years of volunteer work for the Democratic Party, she ran for an open House seat in 1987 and won. Serving since that time, Pelosi was always a strong advocate for health care and medical research. In 2002, she became the first woman to serve as leader of her party in the House of Representatives. Similarly, in 2007, Pelosi became the first woman to serve as Speaker of the House. After two terms, the Democrats lost their majority, but in 2019 they regained it and she served two more terms as Speaker, becoming the fifth longest serving Speaker in U.S. history.

Historical Document

Nancy Pelosi’s Floor Speech on Health Care Reform Bill

Delivered 21 March 2010

Thank you Mr. Speaker. I thank the gentleman for yielding.

I thank all of you for bringing us to this moment. It is great—with great humility and with great pride that we tonight will make for our country and progress for the American people.

Just think, we will be joining those who established Social Security, Medicare, and now tonight, health care for all Americans. In doing so, we will honor the vows of our Founders, who in the Declaration of Independence said that we are all—that “we are all endowed by our Creator certain unalienable Rights” and “among these are Life, Liberty and the pursuit of Happiness.”

This legislation will lead to healthier lives, more liberty to pursue, hopes and dreams and happiness for the American people. This is an American proposal that honors the traditions of our country.

We would not be here tonight for sure without the extraordinary leadership and vision of President Barack Obama. We thank him for his unwavering commitment to healthcare for all Americans. And this began over a year ago under his leadership in the American Recovery and Reinvestment Act where we had very significant investments in science, technology, and innovation for health reform—healthcare reform.

It continued in the President’s budget a few months later, a budget which was a statement of our national values, which allocated resources that were part of our value system and in a way that stabilized our economy, created jobs, lowered taxes for the middle class, and did so—and reduced the deficit; and did so in a way that had pillars of investment including education and health care reform. Health care and education equal opportunity for the American people. And this—And this legislation tonight, if I had one word to describe it would be: “opportunity,” with its investments in health care and education as a continuation of the President’s budget.

We all know, and it’s been said over and over again, that our economy needs something new—a jolt. And I believe that this legislation will unleash tremendous entrepreneurial power into our economy. Imagine a society and an economy where a person could change jobs without losing health insurance; where they could be self employed or start—self-employed or start a small business. Imagine an economy where people could follow their passions and their talent without having to worry that their children would not have health insurance—that if they had a child with diabetes, who was bipolar, or a pre-condition—a pre-existing medical condition in their family, that they would be job locked. Under this bill, their entrepreneurial spirit will be unleashed.

We all know—We all know that the present health care system and insurance system—health insurance system in our country is unsustainable. We simply cannot afford it. It doesn’t work for enough people in terms of delivery of service, and it is bankrupting the country with the upward spiral of increasing medical cost[s]. The best action that we can take on behalf of America’s family budgets and on behalf of the federal budget is to pass health care reform.

The—The best action we can take to strengthen Medicare and improve care and benefits for our seniors is to pass this legislation tonight, pass health care reform.

The best action we can do to create jobs and strengthen our economic security is pass health care reform.

The best action we can take to keep America competitive, ignite innovation—again, unleash entrepreneurial spirit—is to pass health care reform.

With this action tonight, with this health care reform, 32 million more Americans will have health care insurance. And those who have insurance now will be spared being at the mercy of the health insurance industry with their obscene increases in premiums, their rescinding of policies at the time of illness, their cutting off of policies even if you have—have been fully paying but become sick.

The list goes on and on about the health care reforms that are in this legislation. In short: 32 million more people, make it more affordable for the middle class, end insurance company discrimination on pre-existing conditions, improve care and benefits under Medicare, and extending Medicare solvency for almost a decade. Creating a healthier America through prevention, through wellness and innovation, create 4 million jobs in the life of the bill, and doing all of that by saving the taxpayer 1.3 trillion dollars.

Another—Another Speaker, Tip O’Neill, once said, “All politics is local.” And I say to you tonight, when it comes to health care for all Americans: All politics is personal.

It’s personal for the family that wrote to me who had to choose between buying groceries and seeing a doctor. It’s personal to the family who was refused coverage because their child had a pre-existing condition—no coverage the child got worse, sicker. It’s personal for women; after we pass this bill, being a woman will no longer be a pre-existing medical condition.

It’s personal for a senior gentleman I met in Michigan who told me about his wife who had been bed ridden for 16 years. He told me he didn’t know how he was going to be able to pay his medical bills. As I said to you before, “I saw a grown man cry.” He was worried that he might lose his home—that they might lose their home because of his medical bills, and he didn’t know how to pay them. And most of all he was too embarrassed to tell his children and ask them for help. How many times have you heard a story like that?

And it’s personal for millions of families who have gone into bankruptcy under the weight of rising health care cost[s]. In fact, many, many—a high percentage of the bankruptcies in our country are caused by medical bills that people cannot pay. And it’s personal for 45,000 Americans and their—and—and families who have lost a loved on each year because they didn’t and couldn’t get health insurance.

That is why we are proud and also humbled today to act with the support of millions of Americans who recognize the urgency of passing health care reform, and more than 350 organizations representing Americans of every age, every background, every part of the country, who have endorsed this legislation. Our coalition ranges from AARP, who, quote, said that our legislation, quote “improves efforts to crack down on fraud and waste in Medicare, strengthening” Medicare for today—“today’s seniors and future generations.” I repeat, “improves efforts to crack down on fraud and waste in Medicare, strengthening the program for today’s...and future generations of seniors”—to the American Medical Association, the Catholic health Association, the United medical—the United Methodist Church, and Voices [for] America’s Children, from A to Z they are sending a clear message to members of Congress: Say yes to health care reform.

We have also reached this historic moment because of the leadership and dedication of all the members of Congress, but I want to especially recognize our esteemed Chairs, Mr. Waxman, Mr. Rangel, Mr. Levin, Mr. Miller, Mr. Spratt, Ms. Slaughter, for bringing this bill to the floor today. Let us acknowledge them.

And I want to acknowledge the staff of the committees and of the leadership—they have done a remarkable [job?], dazzling us with their knowledge and their know-how.

I would like to thank on my own staff, Amy Rosenbaum, Wendell Primus, and Arshi Siddiqui

And now I want to just close by saying this: It wouldn’t be possible to talk about health care without acknowledging the great leadership of Senator Edward Kennedy, who made health care his life’s work. In a letter to President Obama before he passed away—he left a letter to be read after he died—Senator Kennedy wrote that access to health care was the great unfinished business of our society.

That is, until today.

After more [than] a year of debate—and by the way the legislation that will go forth from here has over 200 Republican amendments; and while it may not get Republican votes and be bipartisan in that respect, it is bipartisan in having over 200 Republican amendments. After a year of debate and hearing the calls of millions of Americans, we have come to this historic moment. Today we have the opportunity to complete the great unfinished business of our society and pass health insurance reform for all Americans. That is a right and not a privilege.

In that same letter to the President, Senator Kennedy wrote what is at stake—he said—“at stake are not just the details of policy...but the character of our country.” Americans will look back on this day [as] one in which we honored the character of our country and honored a commitment to our nation’s Founders for a commitment to life, liberty, and the pursuit of happiness.

As our colleague John Lewis has said, we may not have chosen the time, but the time has chosen us.

We have been given this opportunity. I urge—an opportunity to stay right up there with, again, Social Security, Medicare, health care for all Americans—I urge my colleagues and join together in passing health insurance reform—making history, making progress, and restoring the American dream. I urge an aye vote.

Thank you all very much.

Document Analysis

From the tone of the speech, it seems clear that Speaker Pelosi was confident that she had the votes needed to pass the Affordable Care Act. Even though she was talking in the chambers of the House of Representatives, she was really speaking to the American people. She wanted their ongoing support for this new experiment in the provision of health care insurance and access to health care generally. Pelosi believed that this major change in health care insurance would transform the way in which Americans looked at work opportunities and their personal financial security. She saw nothing but positive outcomes from offering health care insurance to everyone at an affordable cost.

It is clear from the opening references to the Declaration of Independence that Pelosi saw this bill as monumental. By making sure that virtually everyone had health care insurance, she feels confident not only that Americans would have “healthier lives” but that many would use this vigor to undertake to develop a stronger nation through incorporating an entrepreneurial spirit in their lives. That is, without the worries that not having health care insurance tends to bring, people could focus on achieving their goals and desires. This is what Pelosi proclaims in this speech, and what she hoped the American public would understand as one of the foundations for the new law. With the transformation in health care insurance options that the ACA represents, she argues, a resulting four million jobs would be created over the life of the bill. This statement is clearly geared toward appealing to skeptical Americans (among them Independents) as well as to any centrist Republican votes she might hope to get.

As the bill was written, Pelosi and various analysists believed it would cover 32 million people. This expansive pool of participants included people who could not previously obtain insurance on their own (because of preexisting conditions), those who had lost their insurance because the insurance companies judged they had cost too much money, and those who could not afford the premiums for individual health care policies. As she mentions, the law would also expand Medicare coverage by private insurance companies. Between the payments for some services by these companies (rather than by the government) for those sixty-five and older, and more working-age people gaining coverage, Pelose projected a savings of “1.3 trillion dollars.” (Republicans said exactly the opposite, that it would cost untold billions to maintain.)

As Pelosi sets forth in this speech, she holds that adoption of the ACA will create a society in which all individuals will have access to health care, resulting in a heathier, more productive America. She acknowledges that the legislation had not been easy to craft, referring to the 200 Republican-sponsored amendments. However, Pelosi believes that the bill’s adoption will be a step toward including everyone in the nation’s “commitment to life, liberty, and the pursuit of happiness.”

Essential Themes

Since its passage in 2010, Republicans made numerable attempts to repeal the ACA. (“Repeal and replace” was the phrase commonly used, even though no comparable “replacement” bill was ever offered.) Pelosi’s speech was crafted to demonstrate the maximum possible benefits of the legislation, beyond the health care benefits as such. Because of the ACA, people would be able to explore economic and service opportunities that they might not otherwise explore. Previously, most health insurance came through traditional employment, so if a person left their job for, say, an entrepreneurial project or a non-traditional vocation, obtaining new insurance was generally costly if not impossible. As Pelosi states, the health insurance option provided by the ACA would encourage individuals to seek “more liberty to pursue, hopes and dreams and happiness.” This was presented as a strong selling point in attracting votes and getting the legislation through the House.

Speaker Pelosi saw the Affordable Care Act as something for “all Americans.” By doing away with the concept of disqualifying pre-existing conditions, and by providing affordable health insurance, the new plan would greatly expand participation and be more inclusive. Pelosi considered access to health care a right of all Americans, not something that should be available only to those working standard fulltime jobs or wealthier individuals who could afford private insurance. Research shows that having no insurance often equates to receiving no or inadequate health care. Serious illnesses can and often do bankrupt families who are unable to bear the costs on their own. Public use of hospital emergency departments as a primary access point for health care has also been shown to be extremely costly as compared to receiving regular preventive care. These are problems that the ACA was intended to mitigate.

In 2012, the U.S. Supreme Court ruled, in NIFB v. Sebelius, that in one part of the ACA—that part dealing with the expansion of Medicaid in the states—Congress had exceeded its constitutional authority and revoked that part. The equally controversial provision for the “individual mandate,” requiring that people who are currently uninsured sign up for coverage through the ACA, was upheld by the court. By around 2017, the ACA had gained in popularity and received majority support by the public and in Congress.

Bibliography and Additional Reading