Over 35 Years of Expanding Affordable Health Care

Speaker Nancy Pelosi has long been a champion for families' health care, fighting to realize this basic truth: health care is a right, not a privilege. Under her leadership, Democrats have forged generational progress – making quality care more affordable and accessible than ever before.

Speaker Pelosi was the chief architect of the landmark Affordable Care Act (ACA), which stands among Social Security, Medicare and Medicaid as a pillar of families' health and financial security. Under her leadership, the House assembled and passed a sweeping health care reform bill in 2009, laying down a bold marker ahead of negotiations with the Senate. When Democrats lost a filibuster-proof majority in the Senate, Pelosi convinced the Obama Administration not to scale down its ambitions for a comprehensive health care package. After negotiating a compromise bill, she engineered final passage of the ACA in the House – without the help of a single Republican vote.

For more than a decade, the ACA has expanded affordable health coverage for tens of millions more Americans. The law made history by, for the first time, guaranteeing protections for all Americans with pre-existing medical conditions, forbidding insurers from treating being a woman as a pre-existing condition and banning annual and lifetime limits on health coverage.

As Democratic Leader in 2017, Pelosi led the charge to defend American families from Republicans' monstrous efforts to repeal the ACA. Under her leadership, Democrats mobilized a massive nationwide campaign supporting the ACA and opposing the proposed "Trumpcare" legislation. This effort helped power Democrats back into the Majority in 2018.

Since retaking the Majority, Speaker Pelosi has led House Democrats in efforts to strengthen and build on the ACA. The historic American Rescue Plan included House Democrats' provision to slash the cost of health insurance under the ACA: saving families an average of $2,400 in 2021, while helping more families find affordable coverage during the COVID pandemic. With the Inflation Reduction Act, Democrats locked in these savings through 2025: ensuring millions of families will continue to benefit from subsidized coverage.

Speaker Pelosi was the driving force for including the No Surprises Act in the December 2020 omnibus government funding bill. This critical law protects patients from egregious surprise bills for emergency medical services. She also led the House passage of the Affordable Care Enhancement Act, which included a fix to the "family glitch" that prevented nearly a million families from qualifying for ACA subsidies. President Biden realized this key priority in October 2022 with executive action to end this loophole.

For decades, Pelosi has made empowering the federal government to negotiate Medicare drug prices a top priority. Just eight days after gaveling in the 110th Congress, Speaker Pelosi led the passage of the Medicare Prescription Drug Price Negotiation Act. After retaking the Majority in 2018, Pelosi and House Democrats passed H.R.3, the Lower Drug Costs Now Act. In the wake of the pandemic, Speaker Pelosi spearheaded the writing and House passage of the Build Back Better Act, which allowed negotiation over the price of prescription drugs for both public and private insurance programs. Build Back Better also included transformative investments to close the Medicaid coverage gap and expand access to home health care.

While Senate Republicans blocked these bills from becoming law, Pelosi's efforts laid the groundwork for the ground-breaking progress secured in the Inflation Reduction Act. This law included the House-crafted provision allowing Medicare to negotiate for lower drug prices, capped out-of-pocket drug costs for seniors at $2,000 per year, limited insulin copays for seniors at $35 per month, and banned drug companies from raising prices faster than inflation.

In 2007, Speaker Pelosi also achieved a bipartisan agreement to extend the Children's Health Insurance Program, a law that provides health care for nine million American children each year. In 2022, Speaker Pelosi led the charge to enact the Honoring our PACT Act: expanding access to life-saving care for the 3.5 million veterans exposed to deadly toxins in the line of duty, as well as empowering those harmed by water exposure at Camp Lejeune to have their day in court.

While serving as Democratic Leader, Pelosi's strength at the negotiating table wrested critical legislative victories for families' health care out of the GOP majority. In the 114th Congress, she achieved an historic bipartisan agreement to protect Medicare and strengthen its solvency, including by ending the cycle of expensive "Doc Fix" patches and building a system that improves the accuracy of payments and quality of care. She has also delivered significant funding increases for key Democratic priorities, including the fight against the opioid epidemic, support for NIH medical research and permanent authorization of the World Trade Center Health Program.