ICYMI: Pelosi Reflects on “Opportunity of a Generation” Affordable Care Act
Washington, D.C. – This week, Speaker Emerita Nancy Pelosi sat down with Karen Tumulty at The Century Foundation to mark the 15th anniversary of the Affordable Care Act (ACA), calling its passage the “opportunity of a generation” and reflecting on the historic, hard-fought path that led to its enactment.
“We came here to do a job, not keep a job. Despite protests, despite vicious yelling in the Capitol, it was such a joy,” Speaker Emerita Pelosi said. “We thought we were joining the ranks of those who passed Social Security, Medicare and Medicaid.”
Read coverage of the event below:
The Century Foundation: Speaker Emerita Pelosi, President Obama Join Hundreds at TCF Event to Commemorate ACA 15th Anniversary
[Staff Writer, 3/27/25]
Speaker Emerita Nancy Pelosi, Congressional champion of the law, offered insight into the ACA’s passage, including the “atmospherics” the day the legislation passed in the House. Despite protests, yelling that could be heard in the Capitol that she described as “vicious,” she said, “It was such a joy. We thought we were joining the ranks of those who passed Social Security, Medicare, Medicaid.”
Moderator Karen Tumulty, associate editor and columnist at the Washington Post, asked Speaker Pelosi to describe getting the votes in the first place:
For 100 years, presidents had tried to bring health care reform into play, into the lives of the American people, from Teddy Roosevelt on, Franklin Roosevelt, Truman, LBJ with Medicare and Medicaid, and then the Clintons. But, when Barack Obama became president, it was clear, and we had the majority, that we had an opportunity of a generation and we were not going to let another hundred years go by before we passed affordable health care.
She discussed overcoming seemingly intractable issues like abortion (with allies and opponents in nuns and bishops); regional disparities in costs assuaged through late-night negotiations and a letter from U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius committing to action outside of the legislation; and leading the House to support the Senate bill. She described a different letter from “the saintly, remarkable, wonderful” Senate Majority Leader Harry Reid that had the signatures of fifty-one senators supporting changes to the Senate bill necessary for passage in the House. “He made it happen, Harry did.”
One of the most memorable quotes from the fight to pass the ACA was Speaker Pelosi’s statement of her strategy in January 2010 after a special election made the prospects for health reform dim: “You go through the gate. If the gate’s closed, you go over the fence. If the fence is too high, we’ll pole vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people.“ At a press conference after passage, she said she was asked, “which one did you do?”
I said we did the first one: we pushed open the gate because it was not just the courage of my members who were there strongly and knew why they were there, to push open that gate to pass this bill. It was the outside mobilization, it was … all the groups that represented people with one diagnosis or another, it was people who just wanted health care.
The history of the ACA hardly ended with its passage. Speaker Pelosi said “one of the hardest jobs I had in leadership” was preventing repeals of parts of the law. She also discussed the repeal effort in 2017 led by President Trump and the Republican-led Congress: “The thumbs down heard round the world by John McCain really saved the Affordable Care Act but it was saveable because of this outside mobilization.”
Speaker Pelosi also drew from the ACA saga lessons for current debates. She discussed the potential cuts to Medicaid in the current Congress:
We can’t let it happen. It’s just too big a burden for individuals to pay and their families. If you know any people with a child born with other abilities, but not all of them, you would know how important Medicaid is to those children and how it makes a difference in how they can learn and grow and the rest.
Tumulty asked about members of Congress who voted for the bill, knowing that it would likely prevent their reelection in conservative districts, comparing it to current times. She said, “We came here to do a job, not keep a job.”
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