Overview of the Open, Transparent, Lengthy Process of Enacting the Affordable Care Act



  • The House held 79 bipartisan hearings and markups on health insurance reform in 2009 and 2010.
  • In these bipartisan hearings and markups, House Members heard from 181 witnesses from both sides of the aisle, considered 239 amendments (both Democratic and Republican), and accepted 121 amendments.
  • In mark-up, Energy & Commerce Committee adopted 24 GOP amendments.  In mark-up, Education & Workforce Committee adopted 6 GOP amendments.
  • The original House bill was posted online for 30 days before the first Committee began their mark up and more than 100 days before the tri-committees formally introduced their merged bill in the House.
  • House Democrats posted their first House bill online for the promised 72-hour review.
  • The Senate bill voted on in the House was online for three months, and the reconciliation bill was online for 72 hours of review before the final vote.
  • House Democrats heard and answered questions from constituents at more than 3,000 health care town halls and public events, and tens of thousands of e-mails, calls, and letters were logged in Congressional offices to register public comment.


  • The Senate Finance Committee held more than 53 hearings on health insurance reform. They spent 8 days marking up the legislation – the longest markup in 22 years – during which they considered 135 amendments.
  • The Senate HELP Committee held more than 47 bipartisan hearings, roundtables, and walkthroughs on health insurance reform. They considered 300 amendments during a 13 day markup.
  • The Senate Finance Committee posted their legislation online for 6 days before the markup.
  • The Senate HELP Committee posted their legislation online for 6 days before the markup.
  • The Senate spent 25 consecutive days in session on health reform, the second longest consecutive session in history.
  • In total, the Senate spent more than 160 hours considering the health reform legislation.
  • The final Senate bill included 147 Republican amendments.


Trumpcare Hurts American Workers

Trumpcare would be devastating to American workers. The nonpartisan Congressional Budget Office has confirmed that 23 million fewer people will have health insurance, including 3 million who will lose access to a job-based plan. 40,000 people in my district alone could lose their health insurance. We should be working together to grow the economy and create jobs, not take away health insurance from working families who need it.

Trumpcare also repeals many of the vital protections working families rely on. For millions of American workers, the Affordable Care Act (ACA) means that losing a job does not mean losing access to insurance. By guaranteeing coverage for people with pre-existing conditions and with the establishment of the Marketplaces and subsidies, workers now have health care options outside of their employers if they need them.  I worked as an electrician for years and was an hourly worker. While I was lucky enough to be the member of a strong local union and received benefits, not every hourly worker is provided with healthcare options through their job. 

Millions of Americans with pre-existing health conditions have no longer had to worry about being denied coverage or charged higher premiums due to their health status because of the consumer protections under the ACA. That means that if a worker leaves a job to start a business or take time to care for his or her family, there isn’t a reason to worry. That worker has protections against discrimination based on a pre-existing condition. Under Trumpcare, states would be allowed to waive pre-existing protections. Workers would have fewer insurance options and would no longer have guaranteed protections for themselves or members of their family. 

Working families need higher wages, but until Congress acts to raise the wage, it's that much more critical for Americans to feel secure that they'll have health care when they need it. Trumpcare does the opposite.

Not only does Trumpcare hurt workers directly in reference to their own coverage, but it also hurts workers in the health industry. Trumpcare’s cuts to Medicaid and cuts to subsidies for private insurance means fewer funds would go to local hospitals and health centers that support millions of jobs. Estimates show there would be around 2 million fewer jobs in the industry. 

Fewer families with health insurance, less security for workers with pre-existing conditions and fewer jobs overall equals a bad deal for the American worker.

Representative Donald Norcross (NJ-01) is a member of the Committee on Education and the Workforce.

Trumpcare & Workers

Ranking Member Bobby Scott Opposes the #WrongChoiceAct

H.R.10 undermines student loan borrowers and workers saving for retirement

H.R.10 eviscerates the Consumer Financial Protection Bureau (CFPB), which plays a pivotal role in making sure student loan borrowers are treated fairly and receive the protections they deserve. The Dodd-Frank Act established the CFPB, and it also created a student loan ombudsman within CFPB that is tasked with collecting and analyzing complaints submitted by both private and federal student loan borrowers. This crucial work has led to the CFPB taking concrete action to protect student borrowers such as issuing reports highlighting problems in loan servicing and default rehabilitation. In addition, H.R. 10 repeals the “fiduciary rule,” a responsible fix to the problem of “conflicted advice.”  For too long, some financial advisors have been able to exploit loopholes in a decades-old regulation and put their profit motives ahead of their retirement clients’ best interests. This practice costs retirement plan participants $17 billion in losses every year according to President Obama’s Council on Economic Advisors.

Congress should not undermine or eliminate protections for students trying to finance a college education and workers planning for retirement.  Unfortunately, that is precisely what H.R. 10 does. 

RCS Floor


Trumpcare Would Be Devastating for Older Americans

Trumpcare would be devastating for millions of American families, but perhaps no one will bear the brunt of its cruelty more than older Americans. This harmful legislation raises costs and imposes a crushing age tax on older Americans right when they need the money the most – just before retirement. The Affordable Care Act (ACA) prevented insurance companies from charging older enrollees more than three times the rate charged to their youngest enrollees. This ensures coverage is affordable for older Americans. However, under Trumpcare, states could choose to allow insurance companies to increase premiums for older Americans as high as they like, exposing older Americans to exponentially higher premiums. AARP estimates that allowing insurance companies to charge older Americans five times more than younger enrollees would add an average of $3,200 annually to premiums for adults age 60 or older. The nonpartisan Congressional Budget Office also confirmed that older Americans could see their premiums increased by over 800 percent under Trumpcare. About half of households age 55 and older have no retirement savings and these pre-retirement individuals can’t afford more health costs shifted onto them.

In addition to skyrocketing premiums, Trumpcare also unravels protections that older Americans want and need in their health coverage. The ACA currently requires health insurance companies to cover ten categories of essential health benefits in Marketplace plans, including mental health treatment and prescription drug coverage. Trumpcare strips away this guaranteed coverage, potentially leaving millions of older Americans without access to the coverage or the medications they need.  We know that three out of four adults age 50 and over take at least one prescription medication on a regular basis.  Losing access to quality and comprehensive coverage, including for prescription drugs, would be devastating to older Americans.

That’s not all. Trumpcare frees insurers to set premiums for enrollees, including older Americans, based on their health status. This would take us back to the days when health insurance coverage was unaffordable for individuals with pre-existing conditions – especially for the 25 million older adults with pre-existing conditions. Exorbitantly high premiums and coverage that excludes certain conditions, such as hypertension, are, in practice, no different than coverage denials. If an insurer wanted to deny someone coverage, they could simply offer a plan with an overly expensive premium or a plan without the kind of coverage needed.

All in all, Trumpcare is a bad plan for older Americans.

Representative Raja Krishnamoorthi (IL-08) is a member of the Committee on Education and the Workforce.

Pre-Retirement & ACA

Trumpcare Threatens The Health And Future Of Young People

Millennials have seen dramatic gains in health insurance coverage since passage of the ACA, more so than any other age demographic. Instead of building on these historic gains, Trumpcare would have devastating effects on young people.

Trumpcare harms young people by eliminating the current tax credit that helps many young people purchase insurance. According to Young Invincibles, low- and moderate-income young individuals would pay more under Trumpcare than under current law, ultimately impacting over 4 million young people and harming the lowest-income young people the most. On top of that, Trumpcare allows insurers to impose penalties on those who experience gaps in coverage.  Who is most likely to experience a gap in health coverage because of a move or a job transition?  Young adults.  In fact, as many as one-third of young people between the ages of 19 and 34 could face this 30 percent coverage gap surcharge under Trumpcare.

Trumpcare would also mean less access to quality coverage for young adults. Despite the assumption that young people are healthier, an estimated 31 million young adults are living with a pre-existing condition. Keep in mind —before the ACA, people were routinely denied coverage or charged higher rates based on a pre-existing condition. That doesn’t mean just illnesses like cancer, but even allergies, anorexia, or being a survivor of domestic violence. Under Trumpcare, these 31 million young adults would lose guaranteed insurance to cover the medical care they need. Out-of-pocket spending for key services for young adults, such as maternity coverage, mental health care, STD counselling and screenings, and substance use treatment, could increase by thousands of dollars per year — leaving financially-strapped young people to face high out-of-pocket costs they simply cannot afford. 

As young people continue to face a host of financial challenges – student loan debt, saving for retirement or saving up to buy a house, looking for a job, among others – security in health insurance is paramount. I believe that we should do more to improve the financial security of the more than 200,000 young people in my Congressional district, not threaten their health coverage. 

Trumpcare will threaten the health and future of young people across the country.

Representative Adriano Espaillat (NY-13) is a member of the Committee on Education and the Workforce.

Espaillat Young People Blog

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