When the gavel fell late in the afternoon of Sunday, March 21, 2010, the House had passed the Senate version of a comprehensive health care reform bill with a final tally of 219 yeas and 212 nays. Democrats and their supporters celebrated while Republicans pledged to try to repeal or prevent implementation of the law. The vote marked the end of a months-long legislative and political struggle as House and Senate Democrats attempted to find a way to enact one of President Obama's signature issues from the 2008 campaign. The bill's provisions promised to drastically remake the country's health care system, providing a means of coverage for uninsured Americans and requiring all Americans to carry health insurance. The final bill was the result of numerous compromises and many hours of delicate negotiations as the Democratic Party leadership sought to find a way to enact the bill over unified Republican opposition and the electoral fears of many Democrats. The debate and the details of the bill took many twists and turns throughout 2009 and early 2010. The final votes needed to pass the bill were not secured until President Obama promised to issue an executive order stating that the legislation would not undo existing restrictions on the use of federal funds for abortions, which gained the votes of Bart Stupak (D-Michigan) and several other pro-life Democrats. Democrats celebrated the victory as a major expansion of rights for all Americans, while Republicans decried it as an expensive and likely ineffective government intervention into the health care marketplace.

Although the House vote described here was dramatic, there was little real doubt as to the outcome of the vote once the bill was brought to the floor. All the deals had been struck and the votes had been counted and re-counted. The proceedings were carefully choreographed with specific votes on specific amendments allowed while others were prohibited. This is not unusual, as both the House and Senate have developed elaborate committee and party systems that can take much of the policy-making process, deliberation, and compromises off the chamber floors and into more private settings.