The Affordable Care Act’s vote results have run in one direction across nearly two decades: narrow, largely partisan, and closely tied to which side held the procedural high ground. The Senate passed the ACA 60–39 on December 24, 2009; the House passed the same bill 219–212 on March 21, 2010; a Republican repeal push died in the Senate 49–51 in July 2017; and a December 2025 vote to extend the law’s enhanced premium subsidies fell short at 51–48. What follows is each of those roll calls, who crossed party lines, and what the tally actually decided.
Senate Passage, December 24, 2009
The Senate approved H.R. 3590, the Patient Protection and Affordable Care Act, on Christmas Eve 2009 by a vote of 60–39. Every yes vote came from the Democratic caucus, including independents Bernie Sanders of Vermont and Joe Lieberman of Connecticut. All 39 no votes were Republican. Senator Jim Bunning of Kentucky did not vote.1U.S. Senate. Roll Call Vote 396, 111th Congress, 1st Session
The 60-vote total mattered because of what had happened the day before. On December 23, 2009, the Senate voted 60–39 to invoke cloture, the procedural step that ends debate and requires a three-fifths supermajority.2U.S. Senate. Roll Call Vote 395, 111th Congress, 1st Session Democrats held exactly 60 seats in their caucus. Losing a single vote would have handed Republicans a filibuster. That arithmetic gave outsized leverage to Lieberman and Senators Ben Nelson, Mary Landrieu, and Blanche Lincoln, who each extracted concessions during the final round of negotiation.
House Passage, March 21, 2010
The House cleared the Senate’s version of the bill on the night of March 21, 2010, by a vote of 219–212. All 219 yes votes were Democratic. All 178 voting Republicans voted no, and 34 Democrats broke with their party to vote no as well.3Office of the Clerk, U.S. House. Roll Call 1654GovTrack. H.R. 3590, House Vote on Passage Four House seats were vacant at the time, so the total votes cast came to 431 rather than 435.5A Mark Foundation. How the ACA (Obamacare) Was Negotiated
The 34 Democratic dissenters mostly represented conservative-leaning or swing districts, and included Collin Peterson of Minnesota, Dan Lipinski of Illinois, John Barrow of Georgia, and Jason Altmire of Pennsylvania.4GovTrack. H.R. 3590, House Vote on Passage By 2014, only four of those 34 were still serving in Congress.6Politico. Anti-Obamacare Democrats
The Reconciliation Companion Votes
The main bill passed alongside a companion measure, the Health Care and Education Reconciliation Act (H.R. 4872), which carried a package of amendments negotiated between the two chambers. The House initially passed it 220–211 on March 21, 2010, the same night as the ACA vote. The Senate approved it 56–43 on March 25, 2010, and after two minor Senate changes, the House passed the final version 220–207 later that evening.7Social Security Administration. Legislative Bulletin, March 30, 20108U.S. Senate. Roll Call Vote 105, 111th Congress, 2nd Session President Obama signed the ACA on March 23 and the reconciliation act on March 30, 2010.
The 2017 Repeal Attempt
Republicans came closest to unwinding the law in 2017. On May 4 of that year, the House passed the American Health Care Act (H.R. 1628) by a vote of 217–213. All 217 yes votes were Republican; 20 Republicans voted no along with all 193 Democrats.9GovTrack. H.R. 1628, House Vote on Passage10Office of the Clerk, U.S. House. Roll Call 256 The bill aimed to repeal and replace the ACA and defund Planned Parenthood.
The Senate spent the summer of 2017 cycling through repeal drafts. The final attempt, a stripped-down measure called the Health Care Freedom Act and known as “skinny repeal,” came to the floor in the early morning of July 28, 2017. It failed 49–51. Three Republicans voted no: Susan Collins of Maine, Lisa Murkowski of Alaska, and John McCain of Arizona.11U.S. Senate. Roll Call Vote 179, 115th Congress, 1st Session McCain had returned to Washington days after a brain cancer diagnosis and signaled his no with a thumbs-down on the Senate floor.12BBC News. US Healthcare: Senate Rejects ‘Skinny Repeal’ Obamacare Plan He said the bill did not amount to “meaningful reform” and objected to the process of bypassing committee review.13PBS NewsHour. McCain’s Complicated Health Care Legacy
Zeroing Out the Individual Mandate Penalty
Full repeal failed, but Republicans achieved a partial rollback later in 2017 through the Tax Cuts and Jobs Act. Signed in December 2017, it set the ACA’s individual mandate penalty to $0 starting in 2019. The mandate itself technically remained on the books, but the financial consequence for going without coverage was gone, and unlike most individual provisions of that tax law, this change does not sunset.14Tax Policy Center. How Did the Tax Cuts and Jobs Act Change Personal Taxes
The Senate passed the tax bill 51–49 on December 2, 2017, in a nearly straight party-line vote. Republican Senator Bob Corker of Tennessee joined all 48 Democrats and independents in voting no.15U.S. Senate. Roll Call Vote 303, 115th Congress, 1st Session The House approved the final version 227–203 on December 20, 2017; 12 Republicans joined all Democrats in opposition.16Office of the Clerk, U.S. House. Roll Call 699
The 2025 Vote on Enhanced Subsidies
Starting in 2021, Congress temporarily enlarged the ACA’s premium tax credits through the American Rescue Plan and later extended them in the Inflation Reduction Act. Those enhanced credits removed the income cap for eligibility and capped benchmark plan premiums at 8.5% of household income. They expired on December 31, 2025.
In December 2025, a Democratic proposal to extend the enhanced credits for three years failed in the Senate on a 51–48 vote. A majority favored it, but the total was short of the 60 votes needed to overcome a filibuster. Four Republicans crossed the aisle to support extension: Susan Collins, Josh Hawley, Lisa Murkowski, and Dan Sullivan.17NPR. Senate ACA Premium Vote18U.S. Senate. Roll Call Vote 643, 119th Congress, 1st Session
The 2026 House Vote on Subsidies
In the House, four Republicans (Brian Fitzpatrick, Mike Lawler, Rob Bresnahan, and Ryan Mackenzie) signed a discharge petition alongside all House Democrats on December 17, 2025. That reached the 218 signatures needed to force a floor vote over the objections of Republican leadership.19NBC News. Centrist Republicans Revolt, Signing Petition to Force Vote on Obamacare Funding
The House passed the extension bill on January 8, 2026, by a vote of 230–196, with 17 Republicans voting in favor.20Healthcare Dive. House Votes to Revive Enhanced ACA Subsidies Those 17 were Fitzpatrick, Lawler, Bresnahan, Mackenzie, Don Bacon, Mike Carey, Monica De La Cruz, Andrew Garbarino, Jeff Hurd, Dave Joyce, Tom Kean Jr., Nick LaLota, Max Miller, Zach Nunn, Maria Elvira Salazar, David Valadao, Derrick Van Orden, and Robert Wittman.21The Hill. 17 Republicans Who Voted for Obamacare Subsidies The Senate did not take up the House-passed bill, and President Trump had threatened to veto it.22Office of Senator Martin Heinrich. Senator Heinrich Statement on Senate Republicans Blocking ACA Tax Credit Extension
Supreme Court Rulings on the ACA
Congressional roll calls are only part of the record. The ACA also survived three rounds of Supreme Court review, and the vote counts among the justices matter for anyone tracking the law’s fate.
In National Federation of Independent Business v. Sebelius (2012), the Court upheld the individual mandate 5–4. Chief Justice John Roberts wrote that the mandate could not stand under the Commerce Clause but was a valid use of Congress’s taxing power. The same ruling limited the ACA’s Medicaid expansion 7–2, holding that the federal government could not strip states of existing Medicaid funding for refusing to expand, which made expansion effectively optional.23Justia. National Federation of Independent Business v. Sebelius, 567 U.S. 519
In King v. Burwell (2015), the Court ruled 6–3 that premium tax credits were available on the federal exchange, not only on state-run exchanges, rejecting a challenge based on the phrase “established by the State.”24Justia. King v. Burwell, 576 U.S. 47325Oyez. King v. Burwell
In California v. Texas (2021), the Court declined to reach the constitutional question and ruled 7–2 that the challengers lacked standing to sue because the zeroed-out mandate caused them no injury.26Supreme Court of the United States. California v. Texas, 593 U.S. (2021)27SCOTUSblog. Court Again Leaves Affordable Care Act in Place