On March 23, 2010, Vice President Biden and a not-yet-greying President Obama addressed a crowd of 300 exuberant supporters in the East Room of the White House to celebrate the passage of the new health care reform.
"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," Obama said. With 22 strokes of his pens "all of the overheated rhetoric over reform will finally confront the reality of reform," he added. Between Biden and Obama, the words "history" and "historic" were used a total of 17 times.
Five years later, rhetoric has met reality, and that hasn't always worked out for Democrats. People who liked their plans weren't able to keep them. After two brutal midterms for Democrats, many of the officials standing in the room with him have been demoted to minority leader or voted out of office. The Patient Protection and Affordable Care Act—also called the Affordable Care Act, Obamacare, the nation's foremost job killer, and "the worst thing that has happened in this nation since slavery"—is still marginally more unpopular than it is popular.
And yet, health reform is still the law of the land, the uninsured rate has dropped, and Congressional Republicans have yet to rally behind a legitimate alternative. Here are five of the most important days in Obamacare's history since it became law, and why they still matter now.
Nov. 3, 2010: Democrats lose the House
It's hard to pinpoint the extent to which the defeat Democrats suffered in 2010 was a result of the party's health care agenda. What is clear is that the unrest seen during the town halls of 2009, when conservatives blasted Democratic lawmakers for voting for Obamacare, carried over into the election, when the GOP gained 63 House seats, six Senate seats and governorships, and hundreds of state legislature seats.
Robert P. Saldin, an associate political science professor at Harvard argued at the time that "the best evidence suggests that the Affordable Care Act played a leading role in the Republican gains," including studies showing Democrats who voted for the law suffering up to a 5 percent loss of support.
That set the tone for the next midterm election, when "Democrats Run From Obamacare" was a popular headline as candidates cut ads about working to "fix" the law.
June 28, 2012: Court saves individual mandate
If the Supreme Court wanted to destroy Obamacare, it had its best chance with National Federation of Independent Businesses v. Sebelius, a 2012 case on the constitutionality of the individual mandate and the Medicaid expansion.
The court ruled that the individual mandate was constitutional, but the Medicaid expansion was "unconstitutionally coercive." As a result, several red states opted against participating in the expansion, and conservatives later claimed that the moves led to billions in savings for taxpayers. These studies disagreed.
The Kaiser Family Foundation also found that Medicaid expansion states are seeing slower health care cost growth and lower uninsured rates.
Oct. 1, 2013: Healthcare.fail
The first day of Obamacare enrollments was a disaster, even if Obama didn't acknowledge the full extent of the problems for several days. Healthcare.gov users experienced long wait times, the site crashed, and when users could get through they were often met with windows like this:
Some of the state exchanges—mostly in blue states that embraced the law—didn't fare much better, but the failure of the federal site raised more questions about Obama's management skills, and how he could allow the website for his signature law to be so bad. Six months later, Health and Human Services Secretary Kathleen Sebelius—one of the people Obama thanked by name when he signed the law—resigned.
Honorable mention: Dec. 12, 2013, when Politifact named Obama's promise that "If you like your plan, you can keep it," its Lie of the Year.
April 17, 2014: 8 million sign-ups
After six months of website problems, low enrollments, debunked Obamacare horror stories, and being mocked over Pajama Boy, the administration bounced back when enrollments exceeded estimates by the Congressional Budget Office. "We've been having a political fight about this for five years," Obama said during a press conference announcing the totals. "We need to move on to something else."
Republicans, not ready to move on, challenged the 8 million number, which has dropped since then as people change jobs, age into Medicare, or didn't pay their first month's premium. In November, Bloomberg reported that 380,000 dental plans helped pad the enrollment number, and the actual total was 6.7 million. But the argument that no one wanted to sign up for Obamacare was weakened and virtually abandoned by the law's second enrollment period, which saw 11 million sign-ups.
March 4, 2015: Court hears subsidies case
There are dozens of explainers over the last two years on King v. Burwell and the merits of the case, but essentially the court will decide this spring if exchanges "established by the State" applies to the federal exchange. If not, those consumers in those states will lose the subsidies that make their insurance affordable and, as Bloomberg's Joshua Green explained last month, it could also hurt the insurance markets of those states as set up massive political problems for Republicans.
This is the biggest legal challenge to the Affordable Care Act since, well, the last one. And assuming there isn't a Republican president ready to sign a bill repealing the law on his first day in office, it may not be the last. Rhetoric and reality will continue to co-exist.