How the 2010s changed health care

The decade brought America closer to universal coverage. But there’s still a long way to go.

Dec 23, 2019, 4:20 PM UTC

President Barack Obama shortly after he signed the Affordable Care Act into law. Ten years later, more people have health coverage and fewer people go bankrupt over medical bills.

President Barack Obama shortly after he signed the Affordable Care Act into law. Ten years later, more people have health coverage and fewer people go bankrupt over medical bills.

President Barack Obama shortly after he signed the Affordable Care Act into law. Ten years later, more people have health coverage and fewer people go bankrupt over medical bills. Chip Somodevilla/Getty Images

Looking back at the tumultuous 2010s

Dylan Scott is a senior correspondent and editor for Vox’s Future Perfect, covering global health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017.

Ten years ago on Christmas Eve, the Senate passed its version of Obamacare. The 2010s began with the United States taking its most significant steps toward universal health coverage in a generation.

It ends with the country having moved closer to that goal than ever, but still falling short. There have been plenty of bumps along the way. And the debate about how best to provide affordable health care to every American is as vital as it’s ever been.

After the Senate vote 60-39 on December 24, 2009, the first of the law’s many trials soon followed: the death of Sen. Ted Kennedy (D-MA) and the election of Republican Scott Brown to replace him, breaking the Democratic supermajority.

Still, the law passed, thanks to the legislative chicanery by then-Senate Majority Leader Harry Reid and once and future Speaker of the House Nancy Pelosi, and was signed by President Obama in early 2010. The 2010 midterms were disastrous for Democrats, but the law would persist.

In 2012, it overcame its first existential threat at the Supreme Court, when Chief Justice John Roberts found a rationale for upholding the individual mandate and with it the rest of the law. The botched rollout of HealthCare.gov in 2014 might have damaged its reputation and provided catnip for critics, but eventually the marketplaces were up and running. Another SCOTUS case in 2015 left the law intact, once again thanks to Roberts.

Then came the 2016 election of Donald Trump. Republicans finally had a chance to deliver on their promise to repeal and replace the health care law they hated so much. The repeal fight would consume Trump’s first year in the White House.

But Republicans couldn’t overcome a basic change in US health care politics. As the Affordable Care Act’s approval with the public slowly started to improve, public opinion on something else was changing in parallel: Americans had broadly come to believe (again, after a significant dip when the law first passed) the government had a responsibility to make sure everybody had health coverage.