Web Video: The Affordable Care Act signed into law in 2010

MS. IFILL: It’s the law of the land, the most expansive health care overhaul in history. We'll tell you how it happened, what's in it, and why the fight's still not over, tonight on "Washington Week."
PRESIDENT BARACK OBAMA: (From videotape.) Today, after almost a century of trying, today, after over a year of debate, today, after all the votes have been tallied, health insurance reform becomes law in the United States of America. (Applause.)
MS. IFILL: It was a fight to the finish complete with sore losers --
HOUSE MINORITY LEADER JOHN BOEHNER (R-OH): (From videotape.) Hell no, you can't.
REP. MIKE PENCE (R-IN): (From videotape.) We will work in every way to repeal this legislation and start over.
MS. IFILL: -- and astonished winners.
HOUSE SPEAKER NANCY PELOSI (D-CA): (From videotape.) I believe that this is what we came here to do.
MS. IFILL: Changes to Medicare, extended coverage for young adults and the uninsured and for prescription drugs, plus a nearly billion dollar price tag.
MS. IFILL: Good evening. No doubt about it. The president of the United States was one happy man this week. In Iowa, he rubbed it in a bit, reminding supporters that Republican fears about his health care plan had not immediately come to pass.
PRESIDENT OBAMA: After I signed the bill, I looked around to see if there were any asteroids falling or -- (applause). Turned out it was a nice day. People still have their doctors.
MS. IFILL: But the president and his aides know well the political problems have not gone away. A new "National Journal" Insiders poll shows virtually all, 97 percent, of congressional insiders say their party will be more energized by the health bill's passage.
REP. BOEHNER: (From videotape.) The American people aren't taking this lying down. The ink isn't even dry, and there's a grassroots revolt over this bill.
MS. IFILL: Of course, those were the Republicans. This White House Chief of Staff Rahm Emanuel pushed right back on last night's PBS "NewsHour."
WHITE HOUSE CHIEF OF STAFF RAHM EMANUEL: (From videotape.) I'm not in the business of giving political advice to Republicans, but that would not be what the American people want. And if that's the tone and tenor you adopt, I think there's a political price to pay in November.
MS. IFILL: But before we get to the political fight to come, let's recap the one just completed. Ceci how did these things come together? How did all of this come together in the end?
MS. CONNOLLY: Well, after, as you all know, a very long year of twists and turns, it in the end came down to 61 critical, final days that was really on the president at this point finally. And we saw him do the outside game, the sort of rallies. He was in Philadelphia and Ohio and revving up the troops. But much more importantly was the inside Washington game that he was very intimately involved in. It was the traditional arm twisting. It was giving members rides on Air Force One. It was even cornering some of these poor lawmakers at parties, where they thought they were coming to have a cocktail and celebrate one piece of legislation and suddenly he was draping his arm over them, talking about health care and needing their vote.
MS. IFILL: Alexis, now, while the president was doing this revving up, throwing his arm around people, basically twisting arms in all kinds of creative ways, Republicans, not one of whom voted for this, were they pushing or twisting back?
MS. SIMENDINGER: They were actually thinking very confidently about the trajectory of the strategy that they crafted very early in 2009. Their whole idea was to start with the Obama agenda and vote no as often as possible. And on health care, they felt very strongly based on the polls and talking to their constituency, their base that they were right to vote no all the way through. So they were actually very, very pleased with themselves, the solidarity. They were very interested in the kind of exaltation that the grassroots uprising that you heard Mr. Boehner talk about in the house. And there was lots of feeling that they were on the right path, that they can do two things. One is that they can broaden their majorities in the House and Senate. Perhaps take over one or both chambers, and that this will be something that will wrap around President Obama's neck and perhaps make him a one-term president. They feel very sure about that.
MS. IFILL: Now, I want to ask both of you because people are sitting at home tonight saying, okay, fine, this thing you've been talking about it forever. You finally got it. It's now law. What difference does it make to me? So isolate for us some important parts of this law which will affect the most people.
MS. CONNOLLY: Well, it's important to say that many of these provisions are not going to kick in until 2014. It takes a while to implement this kind of change. And for about 160 million Americans today who have health insurance through their jobs, they're not going to see too many big changes. But right away, in a matter of months, people who are under age 26 can stay on their parents' health insurance policy.
A lot of those seniors who get Medicare, falling into the donut hole now where they have to pay full coverage for their drugs, they'll get a rebate this year, and then they'll start getting discounts every year thereafter. That's a couple of them.
MS. IFILL: And a couple more?
MS. SIMENDINGER: Well, and the impositions on the insurance companies kick in right away. Basically this is the kind of thing that the president and Democrats are really trying to tout, that right away insurance companies can't dump you off the coverage. Right away, children are not supposed to be expelled from insurance because of preexisting conditions. Right away, you're supposed to be able to not have a lifetime cap on your insurance. So the benefits are supposed to be the front loaded part of this that we've all talked about. And then when you start seeing the wealthier Medicare recipients pay more taxes is later on. When you start seeing some of the taxes on the Cadillac plans, most expensive health care plans, is way into the future.
So right away, this year, they're really trying to emphasize the next six months. And right away, you're seeing on the Republican side, they're emphasizing how hard it's going to be to implement.
MS. COOPER: But what are the bigger to happen in 2014?
MS. CONNOLLY: Well, in 2014, there'll be creation of this new set of exchanges, kind of think of it as an insurance marketplace or bazaar where people can do some comparison shopping, especially if you're an individual who's having trouble getting insurance or small businesses. Over the next few years, they'll also be providing some more tax credits to small businesses, another group that has a lot of trouble getting health insurance. And then we'll also start to see some of the changes in the way that our health care system works. And the idea is to start getting hospitals and doctors to kind of focus more on quality and less on quantity. And they'll do it by changing the way that they pay them.
MS. SIMENDINGER: On the other I'd add is if this is supposed to be a right, this is what's so landmark about this, that all Americans are suppose to have this right now to health insurance.
MS. IFILL: Or mandated, as Republicans call it.
MS. SIMENDINGER: That's when the 2014 big change happens. It's the mandate that you must have insurance or you're taxed if you don't have it. And that's true for employers and for individuals. That's a huge change.
MS. CONNOLLY: You'll start paying penalties and those will be increasing.
MS. COOPER: So I'm curious about just -- again, I know this is so Washington, but looking at just how President Obama did it, were there lawmakers that he wasn't able to -- who was he not able to convince for instance?
MS. IFILL: With his incredible powers of persuasion.
MS. CONNOLLY: Yes, yes. Well, I really think one of the big disappointments for him early in the year was Olympia Snowe, the Republican senator from Maine, who Obama just believed he was going to bring her onboard and he couldn't. In this final push, it was a congressman from Pennsylvania, outside of Pittsburgh, Jason Altmire, who was showered with presidential attention -- two parties at the White House, phone calls from the president, Rahm Emanuel talking to him, cabinet officials calling. And in the end, Altmire, who knows a lot about health care, worked in the insurance industry, just said, it's not popular in my district.
MS. SIMENDINGER: And then Congressman Kasich, though, came to another conclusion.
MS. CONNOLLY: Yes, he did. And that was a surprise.
MS. IFILL: Congressman Kucinich. Dennis Kucinich. John Kasich, former congressman.
MS. CONNOLLY: Right, Dennis Kucinich from Ohio, who is an advocate of a single payer government style health system, very liberal, he'd been in the White House for meetings, too, and wasn't budging. And then he had this ride aboard Air Force One in the presidential cabin.
MS. COOPER: What's up with the Air Force One rides? (Laughter.)
MS. CONNOLLY: It's a little bit of extra razzle-dazzle, although what he said and others have sort of confirmed my reporting on this is that the president made a very personal appeal and said, you were with me in the early days of the presidential contest, when you told your Iowa delegates if I don't -- Kucinich doesn't win on the first ballot, go ahead and give your support to Obama. That meant a lot to Obama and he was able to sort of bring that back to him and say, look, we've been through so much. My presidency is on the line.
MS. IFILL: Paul, do you have a question?
MR. RICHTER: Yes. A lot of the families that I know are really interested in this idea that their young adult children will be able to stay on health care right away. Is that as easy as it looks or is it going to be some snag with that?
MS. IFILL: Said the parent at the table. (Laughter.)
MS. CONNOLLY: Well, you're right. That is the thing that I have heard from people just in my office and on the street and everything else. We'll have to see, but I think that insurance companies are going to know that they shouldn't be messing around with that one because it's going to be so popular. There would just be an uprising. And I think the White House would probably pounce on them if it didn't occur.
MS. IFILL: Now, we've heard a lot this week about the pushback. The Republicans didn't say, okay, fine, it's law. We'll just go home. They didn't at all. In fact we saw attorneys general, state attorneys general say that they were going to challenge the law. We saw everyone from John McCain to Mitch McConnell say, we would replace and repeal it. John Kyl, one of the ranking members, Republican members of the Senate was on the "NewsHour" earlier this week and he said, oh, well we know we're not going to really do that, which I was surprised at. How serious -- with candor -- it was shocking. How serious are they about not letting this die?
MS. SIMENDINGER: Well, the interesting element of it is the range of opposition. And all of this is to delegitimize what has just happened, to make this law seem a question mark in most voters' minds still. Because there was this long ramp up to the implementation of it, the idea is in the states, mostly Republican attorneys general -- at least there's 14 of them so far -- have at least bonded together in this case in Florida. And they're challenging this on constitutional grounds, based on the Commerce Clause, saying that the federal government doesn't have the right to do this, to impose this on the states.
Most legal experts and certainly the White House are arguing that this is for political show. These cases are being either combined or being filed individually in the states and will not have merit, despite the fact that some of the Republican attorneys general are saying this is going to go to the Supreme Court.
MS. IFILL: And finally, I want to ask you both -- everyone. We've all been in Washington for a while. We've covered big stories like this before. But I've never seen this kind of rancor, this kind of anger on both sides, and this kind of -- partisanship almost seems too small word for what we've seen.
MS. CONNOLLY: I think that rancor is more along the lines that I would think because frankly, this was never going to be a bipartisan endeavor. I think maybe President Obama was the only person in this town who thought that there was a realistic chance of that. But the stakes have become so high because, as Alexis was pointing out; Republicans think they have a chance of winning back Congress or maybe one of those chambers. And they see that opportunity now. It's reminiscent of Newt Gingrich, I would say, and the takeover in '94.
MS. SIMENDINGER: One other thing I was going to add is we're all too young to remember this. But in 1988, there was catastrophic --
MS. IFILL: We're all too young -- (laughter).
MS. SIMENDINGER: -- with Medicare and what happened in 1988 was that there was an uprising a year later by older Americans, who, you may remember, stormed -- from your history books -- stormed Rostenkowski and that was actually a bipartisan bill. That was supposed to be a pay as you go kind of extra benefit. That was bipartisan. This is a very partisan bill. And to see the uprising is what has given McConnell and Boehner and other Republicans hope.
MS. IFILL: Well, it's nothing like an election year to test that theory.