document_title: Consejo Mundial de Lucha Libre

question_text: who is considered the father of la lucha libre in mexico

root

text: Consejo Mundial de Lucha Libre

text: History[edit]

text: Prior to 1933, lucha libre shows in Mexico were primarily promoted by foreign promoters doing the occasional match through Mexico or a few scattered local promoters, especially along the U.S. border, who brought in American professional wrestlers as their main attractions.[1]

tag: p

text: Creation[edit]

text: In 1929, Salvador Lutteroth, who at the time was a property inspector for the Mexican Tax department, moved to Ciudad Juárez near the Mexico/U.S. border. During a trip to El Paso, Texas Lutteroth witnessed a professional wrestling show and was intrigued by the show and especially the main event Greek wrestler Gus Pappas.[1][2] Four years later Lutteroth, along with his financial backer Francisco Ahumada chartered Empresa Mexicana de Lucha Libre (EMLL; The "Mexican Wrestling Enterprise"), the first Mexican owned wrestling promotion in the country. EMLL held their first shown on September 21, 1933, considered the "birth of Lucha libre" and led to Lutteroth being known as "the father of Lucha Libre" .[3]

text: EMLL initially tried to book Arena Nacional, the premier boxing venue in Mexico City but the promoters would not let him rent it, forcing Lutteroth and EMLL to take up residence in Arena Modelo, an abandoned and run down facility that Lutteroth was able to use as his home base. The concept of Lucha Libre quickly became very popular, so much so that the EMLL 1st Anniversary Show drew a sell out crowd of 5,000 paying fans. In 1934, an American wrestler debuted in Mexico under a black, leather mask, and Lutteroth dubbed him "La Maravilla Enmascarada" or "The Masked Marvel". In the United States the concept of the masked wrestler was more of a mid-level attraction, but the reaction to La Maravilla Enmascarada led to Lutteroth and the EMLL officials to introduce more masks, starting with a wrestler known simply as El Enmascarado ("the Masked Wrestler") and late on El Murciélago Enmascarado ("The Masked Bat"). Through the use of the masks and ring characters EMLL helped create the sacred position of the mask in Lucha libre, making it the ultimate status symbol for luchadors.[1][2] In the early days of EMLL most of the top names were Americans, but with time EMLL introduced several Mexican natives that became so popular that they began to main event most of the EMLL shows. In order to expand their business EMLL began working with a number of local wrestling promoters across Mexico, allowing them to use the EMLL name and some of their contracted wrestlers while also gaining access to local wrestlers in return. Each booking office was independent of each other but the main office in Mexico City had the final say if there were disputes over who would be able to book certain wrestlers.[1][2]

text: In 1942, a masked wrestler clad in silver, simply known as El Santo ("the Saint"), a man who go on to become a cultural icon in Mexico and is often cited as the greatest Mexican wrestler of all time.[4] With the popularity of El Santo as well as other Mexican stars such as Bobby Bonales, Tarzán López, Cavernario Galindo and Gory Guerrero Arena Modelo eventually became too small to accommodate the demand for tickets. To solve the problem Lutteroth financed the construction of Arena Coliseo in Mexico City, the first arena in Mexico built specifically for professional wrestling and the first sports building in Mexico to have built in air conditioning. The arena, nicknamed the "Lagunilla Funnel" due to its interior shape would hold over 8,800 spectators when configured for Lucha libre or boxing. Arena Coliseo began hosting EMLL's annual Anniversary shows starting with the 10th Anniversary show.[1][5][6]

text: In 1953, Salvador Lutteroth joined the US based National Wrestling Alliance (NWA), becoming the official NWA territory for all of Mexico, known as "NWA-EMLL" outside Mexico. By joining the NWA, Lutteroth and EMLL gained control of the NWA World Light Heavyweight Championship. They were also able to re-brand their "World Middleweight Championship" to become the NWA World Middleweight Championship and their "World Welterweight Championship" became the NWA World Welterweight Championship.[7][8][9] In the early 1950s television became as a viable entertainment medium in Mexico which was set to bolster the popularity of EMLL, but Arena Coliseo was not equipped properly for television transmissions. As it turns out luck was on Lutteroth and EMLL's side as Lutteroth and the personnel at Arena Coliseo bought a lottery ticket worth 5 million Pesos. Lutteroth used his portion of the winnings to finance the construction of Arena México, on the location where Arena Modelo used to sit. Arena México enabled EMLL to broadcast their weekly wrestling shows across Mexico, yielding a popularity explosion for the sport.[1][2] Starting in 1956, with the EMLL 23rd Anniversary Show all anniversary shows were held in Arena México, except the EMLL 46th Anniversary Show. Over time the arena became known as "The Cathedral of Lucha Libre".

text: Over time, Lutteroth retired from the day-to-day operations of EMLL leaving the company in the hands of his son Salvador "Chavo" Lutteroth Jr.[1][2] in 1975 local promoter Francisco Flores, along with EMLL trainer Ray Mendoza broke away from EMLL, citing their displeasure with EMLL's conservative, restrictive promotional style. The two took a number of EMLL's younger wrestlers with them to form Lucha Libre Internacional, S. C, later known as the Universal Wrestling Association (UWA).[2] With the creation of the UWA EMLL faced a rival national promotion for the first time.[10]

text: Becoming CMLL[edit]

text: In the mid-1980s, Chavo Lutteroth retired, allowing his nephew Paco Alonso, grandson of Salvador Lutteroth, to take control of EMLL. In the late 1980s EMLL decided to leave the NWA, seeking to distance themselves from the political infighting in the National Wrestling Alliance. In 1991 EMLL changed their name to Consejo Mundial de Lucha Libre (CMLL; "World Wrestling Council") to establish a new identity after the NWA split.[5] From 1991 through 1993 CMLL created eight "CMLL World" titles in addition to the three NWA branded titles they retained and a slew of other championships.[11] At the start of the 1990s the company began appearing on the national Televisa network, which led to a second big boom in business due to the renewed national television exposure, in the mid-1970s through the 1980s, magazines and newspapers were the sole medium of Lucha Libre for most Mexicans.

text: AAA split and rivalry[edit]

text: In the mid-1980s, retired wrestler Antonio Peña became one of the main bookers for EMLL, helping determine who would win matches, what storylines to use and so on, he was also a driving force behind the name change to Consejo Mundial de Lucha Libre.[12] Peña would often clash with Juan Herrera, the other main booker for CMLL at the time. Herrera wanted to maintain the old style of booking with heavyweights such as Atlantis, El Dandy and El Satánico, while Peña wanted to feature younger, faster moving wrestlers such as Konnan, Octagón or Máscara Sagrada. In the end CMLL owner Paco Alonso decided to go with Herrera's booking style.[13]

text: After Paco Alonso chose to ignore Peña's booking ideas, Peña began negotiations with Televisa television channel to fund a new wrestling promotion that would provide Televisa with weekly wrestling shows. In 1992 Peña started a booking agency, providing wrestlers and matches for the Televisa owned Asistencia Asesoría y Administración (AAA) promotion. While Peña technically owned the promotion Televisa owns the rights to the AAA name.[12] In a move that mirrored Flores' departure in the 1970s Peña left the promotion alongside a number of young wrestlers who were unhappy with their position in the promotion. With the creation of AAA the promotion replaced the UWA as Mexico's other main wrestling promotion, creating a long running rivalry between CMLL and AAA.[12] Starting in 1996 CMLL began promoting an annual show in March, first paying homage to Salvador Lutteroth, then later Lutteroth and El Santo and then finally becoming the Homenaje a Dos Leyendas ("Homage to Two Legends") annual show series.[14][15][16]

text: CMLL in the 21st century[edit]

text: From 2007 to 2009, CMLL had a working relationship with American promotion Total Nonstop Action Wrestling, which saw CMLL's Averno, Rey Bucanero, Último Guerrero and Volador, Jr. winning the 2008 TNA World X Cup and TNA worker Alex Shelley winning the 2008 CMLL International Grand Prix. In 2008, CMLL established a working relationship with New Japan Pro Wrestling as part of "G-1 World", several wrestlers have since toured between the two companies winning titles, including Místico winning the IWGP Junior Heavyweight Championship and Jushin Thunder Liger winning the CMLL Universal Championship tournament. Since 2011, the two promotions have annually co-promoted events in Japan, under the name Fantastica Mania. In 2011, CMLL established a working relationship with Japanese women's promotion Universal Woman's Pro Wrestling Reina and announced that the two promotions would create a new championship for women who have been in the professional wrestling industry for less than ten years, called the CMLL-Reina International Junior Championship. This was followed by the establishment of the CMLL-Reina International Championship one year later.

text: On March 16, 2010, a video was posted on YouTube featuring an interview David Marquez had with NWA Executive Director and Legal Counsel Robert Trobich. Trobich announced that CMLL did not have permission to use the NWA trademark. The rights to usage of the NWA trademark in Mexico is now held by NWA Mexico, represented by Blue Demon, Jr. CMLL replaced the three championships with the NWA World Historic Light Heavyweight Championship, NWA World Historic Middleweight Championship and the NWA World Historic Welterweight Championship.[17][17]

text: On September 19, 2014, CMLL became only the second promotion in the Americas, after WWE, to draw a $1 million gate with their 81st Anniversary Show, headlined by a Mask vs. Mask match between Atlantis and Último Guerrero.[18]

text: On November 6, 2014, the promotion made an alliance with the Mexican independent group Lucha Libre Elite to help bring independent wrestlers into CMLL.

text: On July 6, 2016, NJPW announced that they would broadcast CMLL Friday shows in their video-streaming service, NJPW World.[19] On August 10, CMLL announced a working relationship with American promotion Ring of Honor (ROH). The two promotions were linked through their separate relationships with NJPW.[20]

text: On May 8, 2017, CMLL announced that it was opening Freedom sports bar & Grill And the priest-wrestler Fray Tormenta gave the blessing to the Freedom Arena Mexico, before it opens its doors to the public next Friday May 12.

text: Style and television[edit]

text: CMLL regularly runs seven shows on five days in a week. The biggest weekly show being the Friday night Super Viernes ("Super Friday") show held in the famous Arena Mexico in Mexico City. CMLL runs show at Saturday in Arena Coliseo, at Sunday (two shows) in Arena Mexico and Arena Coliseo Guadalajara, Monday in Arena Puebla, and Tuesday in Arena Mexico and Arena Coliseo Guadalajara. The Super Viernes, the Monday Arena Puebla, and the Tuesday Arena Mexico show are televised.[21][22]

text: Of all the major professional wrestling promotions in the world, CMLL is one of the most conservative, having earned the nickname "The serious and the stable" (La Seria y Estable) over time.[23] Matches with blood are not broadcast unless it accidentally happens during a live event. CMLL rarely uses specialty or "gimmick matches" outside a limited number of steel cage matches and the occasional Super Libre, no-disqualification matches. While other promotions have adopted matches such as the ladder match, CMLL remains much more traditional. They also have strict rules for what they will allow to happen during their shows, on one occasion a match between Dr. Wagner Jr. and L.A. Park during the CMLL 75th Anniversary Show degenerated into a brawl on the floor that was so out of control that both wrestler were fired by CMLL a short time later.[24] CMLL also has strict rules on what wrestlers can and cannot say during their shows, a rule illustrated in 2015 where L.A. Park was fired from the promotion only three weeks after returning due to a profanity laden rant during a CMLL show.[25]

text: CMLL's main programming, hosted by Alfonso Morales, Leobardo Magadan and Miguel Linares, is broadcast regularly on Televisa in Mexico, on LATV in the United States, and formerly on Telelatino in Canada and The Wrestling Channel in the United Kingdom. CMLL also had a syndicated show called "Sin Limite de Tiempo" ("with no time limit") which shows matches from Arena Coliseo shows and matches they could not fit onto the regular broadcast. It aired in Los Angeles on KWHY and Also Air in San Francisco on KEMO-TV. This show was followed up by "Guerreros del Ring" on Canal 52MX. Also, Spanish-language American sports channel Fox Sports en Español recently started broadcasting CMLL programming. Recently CMLL also added the Mexican network Cadena Tres to its list of networks airing CMLL Wrestling. Galavision began airing CMLL wrestling in the spring of 2011. Galavision shows only a one-hour version while LATV has shown a two-hour version. In 2015 several of CMLL's shows became available live on their YouTube channel and they have held a number of internet-Pay Per Views (PPVs)

text: Major shows[edit]

text: Each year CMLL promotes a number of signature events, some shown as pay-per-view events and others shown on regular television. Over the last couple of years CMLL have held three regular events each year and a number of one off, special events. The Major show, shown in order of when they happen during the year, include:

text:
Event
Created
Next/Most recent date
Notes

Entre el Cielo y el Infierno
2010
000000002010-10-15-0000October 15, 2010
A name used either as the main name or as the "tag line" for various shows. The 2010 show was the first promoted specifically under the Entre el Cielo y el Infierno ("Between heaven and hell") name.[26]

Fantastica Mania
2011
000000002017-01-13-0000January 13, 2017
Shows co-produced with New Japan Pro Wrestling, held in Japan in January each year. The most recent show was the Fantastica Mania 2017 show.[27]

La Hora Cero
2009
000000002009-01-11-0000January 11, 2009
A one time pay-per-view.[28]

Homenaje a Dos Leyendas
1996
000000002018-03-16-0000March 16, 2018
Annual show since 2005, honors 2 "legends", one is always Salvador Lutteroth, CMLL's founder. Last event was the 2018 edition.

Infierno en el Ring
2008
000000002016-12-25-0000December 25, 2016
Infierno en el Ring is an annual "multi-person" Steel Cage elimination match, sometimes it gets its own show, in other years it's the main event of another Major Event. The most recent event was the 2016 Infierno en el Ring.[29]

CMLL Anniversary Show
1934
000000002017-09-16-0000September 16, 2017
The biggest show of CMLL's year, commemorates CMLL's debut in 1933. The longest running annual show in professional wrestling. The last anniversary show was 84th Anniversary held on September 16, 2017.

Sin Piedad
2000
000000002016-01-01-0000January 1, 2016
Traditionally CMLL's "End of year" show. Last show held was the 2016 Sin Piedad.[30]

Juicio Final
1991
000000002014-08-01-0000August 1, 2014
Held intermittently since 1990. Most recently the 2014 Juicio Final[31]

Sin Salida
2009
000000002015-07-17-0000July 17, 2015
Held intermittently since 2009. Most recent show was Sin Salida (2015).[32]

tag: table

text: Roster[edit]

text: Championships[edit]

text: Current[edit]

text:
Championship
Current champion(s)
Date won
Reign
Days held
Ref

CMLL World Heavyweight Championship
Corleone, MarcoMarco Corleone
000000002017-06-06-0000June 6, 2017
1
374+
[33]

CMLL World Light Heavyweight Championship
Niebla Roja
000000002017-06-10-0000June 10, 2017
1
370+
[34]

CMLL World Middleweight Championship
El Cuatrero
000000002018-01-19-0000January 19, 2018
1
147+
[35]

CMLL World Welterweight Championship
Mephisto
000000002016-05-04-0000May 4, 2016
2
772+
[36]

CMLL World Lightweight Championship
Dragon Lee
000000002016-03-04-0000March 4, 2016
2
833+
[37]

CMLL World Mini-Estrella Championship
Shockercito
000000002017-03-05-0000March 5, 2017
1
467+
[38]

CMLL World Tag Team Championship
Valiente and Volador Jr.
000000002018-03-17-0000March 17, 2018
1/2
90+

CMLL World Trios Championship
Sky Team
(Místico, Valiente and Volador Jr.)
000000002015-02-13-0000February 13, 2015
1
1218+
[39]

CMLL World Women's Championship
Dalys la Caribeña
000000002016-03-11-0000March 11, 2016
1
826+
[40]

NWA World Historic Light Heavyweight Championship
Hechicero
000000002016-11-02-0000November 2, 2016
1
590+
[41]

NWA World Historic Middleweight Championship
Último Guerrero
000000002015-08-31-0000August 31, 2015
1
1019+
[42]

NWA World Historic Welterweight Championship
Matt Taven
000000002018-03-30-0000March 30, 2018
1
77+
[31]

text:
Championship
Current Champion(s)
Held since
Reigns
Days
held
Ref.

CMLL Arena Coliseo Tag Team Championship
Esfinge and Tritón
000000002018-03-10-0000March 10, 2018
1
97+
[43]

Mexican National Heavyweight Championship
El Terrible
000000002017-10-29-0000October 29, 2017
1
229+

Mexican National Light Heavyweight Championship
Atlantis
000000002015-08-24-0000August 24, 2015
1
1026+
[44]

Mexican National Welterweight Championship
Soberano Jr.
000000002017-05-12-0000May 12, 2017
1
399+
[45]

Mexican National Lightweight Championship
Eléctrico
000000002013-08-13-0000August 13, 2013
1
1767+
[46]

Mexican National Trios Championship
Nuevo Generacion Dinamitas
(El Cuatrero, Forastero and Sansón)
000000002017-07-25-0000July 25, 2017
1
325+
[47]

Mexican National Women's Championship
Princesa Sugehit
000000002016-02-25-0000February 25, 2016
1
841+
[48]

text:
Championship
Current Champion(s)
Held since
Reigns
Days
held
Ref.

Occidente Heavyweight Championship
Furia Roja
000000002018-03-13-0000March 13, 2018
1
94+
[49]

Occidente Light Heavyweight Championship
Puma
000000002015-07-23-0000July 23, 2015
1
1058+
[50]

Occidente Middleweight Championship
Jocker
000000002016-01-31-0000January 31, 2016
1
866+

Occidente Welterweight Championship
Star Black
000000002016-09-25-0000September 25, 2016
1
628+
[51]

Occidente Tag Team Championship
El Rielero and Vaquero Jr.
000000002017-07-16-0000July 16, 2017
1
334+

Occidente Trios Championship
Nuevo Generacion Dinamitas
(El Cuatrero, Forastero and Sansón)
000000002015-11-01-0000November 1, 2015
1
957+
[52]

text:
Championship
Current Champion(s)
Held since
Reigns
Days
held
Ref.

CMLL-Reina International Championship
Zeuxis
000000002017-08-13-0000August 13, 2017
1
306+
[53]

CMLL-Reina International Junior Championship
Kaho Kobayashi
000000002017-09-15-0000September 15, 2017
1
273+
[54]

FULL World Championship
Rey Bucanero
000000002016-04-30-0000April 30, 2016
1
776+
[55]

text:
Championship
Last Recognized Champion(s)
Date created
End of Recognition
Ref.

CMLL Japan Super Lightweight Championship
Ricky Marvin
000000001999-02-27-0000February 27, 1999
000000002000-08-06-0000August 6, 2000
[56]

CMLL Japan Tag Team Championship
Masato Yakushiji and Naohiro Hoshikawa
000000001999-02-24-0000February 24, 1999
000000001999-07-07-0000July 7, 1999
[56]

CMLL Japan Women's Championship
Chikako Shiratori
000000001999-10-17-0000October 17, 1999
000000002000-02-13-0000February 13, 2000
[56]

LLA Azteca Championship
Místico
000000002009-12-19-0000December 19, 2009
000000002013-05-12-0000May 12, 2013
[57]

Mexican National Middleweight Championship
Blue Panther
000000001933-01-01-00001933
000000001992-01-01-00001992
[58]

Mexican National Mini-Estrella Championship
Mascarita Dorada
000000001993-01-08-0000January 8, 1993
000000002004-11-05-0000November 5, 2004
[59]

Mexican National Tag Team Championship
Los Destructores
(Tony Arce and Vulano)
000000001957-06-14-0000June 14, 1957
000000001993-01-01-00001993
[60]

NWA Intercontinental Heavyweight Championship
El Faraón
000000001990-10-01-0000October 1990
000000001990-11-01-0000November 1990
[61]

NWA World Light Heavyweight Championship
El Texano Jr.
000000001952-11-06-0000November 6, 1952
000000002012-08-12-0000August 12, 2012
[62]

NWA World Middleweight Championship
Averno
000000001939-01-01-00001939
000000002012-08-12-0000August 12, 2012
[62]

NWA World Welterweight Championship
Mephisto
000000001946-03-15-0000March 15, 1946
000000002012-08-12-0000August 12, 2012
[62]

Occidente Lightweight Championship
Pluma Negra
000000001985-01-01-00001985
000000002006-01-01-00002006

IWC World Heavyweight Championship
La Parka
000000001995-09-01-0000September 1995
000000001996-07-01-0000July 1996
[63]

text: Tournaments[edit]

text: CMLL conducts several annual tournaments which usually signify a big push. Tournaments have been left out of the schedule for unexplained reasons. Some tournaments are conducted as torneo ciberneticos, a large multi-man tag team elimination match, others are normal single elimination tournament.

text: Active tournaments[edit]

text:
Tournament
Last winner
Last held
Notes

Campeonato Universal
(Universal Champion)
Volador Jr.
000000002017-07-14-0000July 14, 2017[64]
An elimination tournament consisting of all champions to determine the "Universal champion". Winner received a title belt but it is defended in the annual tournament.

International Gran Prix
Diamante Azul
000000002017-09-01-0000September 1, 2017[65]
Previously an elimination tournament, now a torneo cibernetico. Features a "Mexico vs. International" wrestlers theme with one side being native Mexicans and the other side of the Cibernetico being foreigners, in 2008 it featured several Total Nonstop Action Wrestling wrestlers.

Leyenda de Azul
("Blue Legend")
Rush
000000002017-12-22-0000December 22, 2017[66]
A tournament in honor of Blue Demon. It is secondary to the Leyenda de Plata tournament but features most of the top wrestlers in the promotion. It has been conducted as a normal torneo cibernético and as a one night tournament.[67]

Leyenda de Plata
("Silver Legend")
Volador Jr.
000000002017-10-20-0000October 20, 2017[68]
A tournament in honor of El Santo. This has been the most prestigious of the CMLL tournaments and the tournament is usually made up of the best in-ring workers.

Reyes del Aire
("Kings of the Air")
Ángel de Oro
000000002017-04-07-0000April 7, 2017[69]
This tournament is for high flyers. The tournament usually works as a cibernetico with mostly young and undercard tecnicos, with the idea of focusing more attention on the winner. Most recent tournament was the 2017 CMLL Reyes del Aire tournament.

Pequeños Reyes del Aire
("Miniature Kings of the Air")
Shockercito
000000002015-01-06-0000January 6, 2015[70]
Like the Reyes del Aire but for Mini-Estrellas

Torneo Gran Alternativa
("Great Alternative" Tournament)
Carístico and Soberano Jr.
000000002017-06-16-0000June 16, 2017[71]
An elimination tag team tournament where an established star teams with a young midcarder with the intent to give the younger wrestler more credibility.

Torneo Nacional de Parejas Increibles
("National Incredible Pairs" Tournament)
El Terrible and Rush
000000002018-02-23-0000February 23, 2018[72]
An elimination tag team tournament where a rudo (bad guy) and a tecnico (good guy) team up.

La Copa Junior
("The Junior Cup")
Niebla Roja
000000002017-12-01-0000December 1, 2017
This tournament features wrestlers who are at least second generation wrestlers, though worked family relations have been accepted as well.

En Busca de un Ídolo
("In Search of an Idol")
Boby Zavala
000000002015-08-21-0000August 21, 2015
An eight-man tournament with the purpose of identifying which of the "Rookies" in the tournament would move up the ranks of the promotion. The 2015 tournament has been announced.[73]

Rey del Inframundo
("King of the Underworld")
Sansón
000000002017-11-03-0000November 3, 2017
An eight-man tournament with the purpose of win El Rey del Inframundo. Winner received a title belt but it is defended in the annual tournament.[74]

text: Past annual tournaments[edit]

text: These are all the tournament that have been held in the past by Consejo Mundial de Lucha Libre but have not been promoted in the last two years.

text:
Tournament
Last winner
Last held
Notes

Copa de Arena Mexico
Team Tall
(Black Warrior, Lizmark, Jr., and Rayo de Jalisco, Jr.)
000000002002-07-05-0000July 5, 2002[75]
A one night tournament for trios teams. The winners earns a trophy; each team comes up with a name for their trio. The tournament was only held in 1999, 2001, and 2002. In 1999, the winners were El Satánico, Rey Bucanero and Último Guerrero as "Team Guerreros del Infierno". The 2001 winners were Black Warrior, Shocker, and Apolo Dantes as "Team Shocker".

Forjando un Ídolo
Ángel de Oro
000000002011-05-27-0000May 27, 2011[76]
A 16-man tournament with the purpose of identifying which of the "Rookies" in the tournament would move up the ranks of the promotion.[76]

Torneo Sangre Nueva
("New Blood Tournament")
Soberano, Jr.
000000002013-03-11-0000March 11, 2013[77]
Tournament for the younger and lower ranked wrestlers in CMLL.[77]

Torneo Increibles de Parejas, Arena Puebla
Atlantis and Volador, Jr.
000000002013-04-01-0000April 1, 2013[78]
An elimination tag team tournament where arudo (bad guy) and a tecnico (good guy) team up.


document_title: How to Train Your Dragon (film)

question_text: who voices gobber in how to train your dragon

text: How to Train Your Dragon (film)

text: Plot[edit]

text: The Isle of Berk is a remote Viking village, from which dragons periodically steal livestock. Hiccup, the awkward fifteen-year-old son of the village chieftain, Stoick the Vast, is too small to fight the dragons and instead fashions mechanical devices under his apprenticeship with Gobber the blacksmith, though his inventions often backfire. During one attack, Hiccup believes he has shot down a Night Fury, an extremely rare and dangerous dragon. Hiccup later finds it in the forest trapped in his bolas, but finds that he can't bring himself to kill the dragon and instead sets it free.

text: Stoick assembles a fleet to find the dragons' nest, leaving Hiccup in a dragon-fighting class taught by Gobber. Hiccup returns to the forest to find the Night Fury still there, and realizes it is unable to fly properly because of its crippled caudal fin. Hiccup gradually tames the dragon and gives it the name "Toothless", for its retractable teeth. Hiccup makes a harness and prosthetic fin that allows him to guide the dragon in free flight. By studying Toothless's behavior, Hiccup becomes proficient in subduing the captive dragons during training. Stoick's fleet arrives home unsuccessful, but he is cheered by Hiccup's unexpected success.

text: Astrid, a tough Viking girl on whom Hiccup has a crush, discovers Hiccup is training Toothless, but Hiccup takes her for a ride to demonstrate his relationship with the dragon before she can tell the village. Toothless unexpectedly takes the pair to the dragons' nest where they discover a gargantuan dragon named the Red Death,2 which eats the smaller dragons unless they bring it stolen livestock.

text: Back at the village, Hiccup subdues a captive dragon in his final training test in front of his father instead of killing it, but Stoick inadvertently angers the dragon into attacking. Toothless attempts to protect Hiccup in the ensuing panic but is instead captured by the Vikings. Hiccup accidentally reveals to Stoick that Toothless is capable of locating the dragons' nest. Stoick disowns his son and sets off for the nest with Toothless chained to the lead ship as a guide.

text: The Vikings expel most of the dragons but are overwhelmed by the Red Death until Hiccup, Astrid and their fellow pupils fly in riding the training dragons from the academy and provide cover fire. Hiccup almost drowns trying to break Toothless free from a sinking ship but Stoick saves them both and then reconciles with his son. Toothless and Hiccup destroy the Red Death but Hiccup is injured in the fight. Hiccup regains consciousness on Berk where his lower left leg has been replaced by a prosthesis, and the Vikings and the dragons now live in harmony.

text: Voice cast[edit]

text: Jay Baruchel as Hiccup Horrendous Haddock III: companion of Toothless, a Night Fury.

tag: ul

text: Gerard Butler as Stoick the Vast, the chieftain of the Viking tribe and Hiccup's father. A fierce, immensely strong and utterly fearless, warrior.

text: Craig Ferguson as Gobber the Belch: blacksmith, a close friend of Stoick's, and training master of the young warriors. He is the mediator between Hiccup and Stoick. He is missing his right foot and his left hand, the latter of which he has replaced with a variety of specialized prosthetics.[3]

text: America Ferrera as Astrid Hofferson, Hiccup's fellow student.

text: Christopher Mintz-Plasse as Fishlegs Ingerman: an enthusiastic youth, knowledgeable in dragon lore narrated role-playing game terms.[4]

text:
Jonah Hill as Snotlout Jorgenson, one of Hiccup's dragon-training classmates. Snotlout is brash, overconfident, and fairly unintelligent, but reliable.
T. J. Miller and Kristen Wiig as Tuffnut and Ruffnut Thorston, a pair of quarrelsome twins.
David Tennant as Spitelout. A Viking who is not named in the film, he appears to be Stoick's second-in-command and Snotlout's father. Tennant has previously narrated a series of Hiccup adventures on audio book.[5]
Robin Atkin Downes as Ack
Philip McGrade as Starkard
Kieron Elliot as Hoark the Haggard
Ashley Jensen as Phlegma the Fierce

text: Production[edit]

text: The book series by Cressida Cowell began coming to attention to the executives at DreamWorks Animation in 2004. Coming off her success in Over the Hedge, producer Bonnie Arnold shortly became interested in the newly acquired property. She kept focusing on the project as time went on, and when DreamWorks Animation co-president of production Bill Damaschke asked her what she wanted to work on next, she chose “How to Train Your Dragon”.[6]

text: In initial development, the plot followed the original novel closely, but about halfway through production Chris Sanders and Dean DeBlois, the writer-directors of Disney's Lilo & Stitch, took over as co-directors and it was altered. The original plot was described as, "heavily loyal to the book", but was regarded as being too "sweet" and "whimsical" as well as geared towards a too-young demographic, according to Baruchel.[7] In the novel, Hiccup's dragon, Toothless, is a Common or Garden Dragon, a small breed. In the film, Toothless is a Night Fury, the rarest of all dragons, and is large enough to serve as a flying mount for both Hiccup and Astrid. The filmmakers hired cinematographer Roger Deakins (known for frequently collaborating with the Coen brothers) as a visual consultant to help them with lighting and overall look of the film and to "add a live-action feel".[7] Extensive research was done to depict both flight, as the directors knew they would be the biggest draw of the film's 3D effects, and fire, given animation could break away from the limitations seen in live-action films, where propane flames are usual due to being easier to extinguish. The dragons' design made sure to create animals that were comical and also innovative compared to other dragon fiction. Toothless in particular tried to combine various dragon traits in a black panther-inspired design, that also had large ears and eyes to convey emotion better.[8]

text: The directors made sure to cash in the improvisation abilities of the secondary cast—Christopher Mintz-Plasse, Jonah Hill, Kristen Wiig and T.J Miller—by frequently bringing them together in the recording sessions.[2]

text: Music[edit]

text: John Powell returned to DreamWorks Animation to score How to Train Your Dragon, making it his sixth collaboration with the studio, following his previous score for Kung Fu Panda (which he scored with Hans Zimmer). Powell composed an orchestral score, combining bombastic brass with loud percussion and soothing strings, while also using exotic, Scottish and Irish tones with instruments like the penny whistle and bagpipes. Additionally, Icelandic singer Jónsi wrote and performed the song "Sticks & Stones" for the film. The score was released by Varèse Sarabande on March 23, 2010.

text: Overall, the score was well received by film score critics. Powell earned his first Academy Award nomination for his work on the film, ultimately losing to Trent Reznor and Atticus Ross for their score for The Social Network.

text: Release[edit]

text: How to Train Your Dragon had its United States premiere on March 21, 2010, at the Gibson Amphitheatre in Universal City, California.[9] It was theatrically released on March 26, 2010, in the United States.[10] The film was digitally re-mastered into IMAX 3D, and released to 186 North American IMAX theatres, and approximately 80 IMAX theatres outside North America.[10]

text: Competition for 3D screens[edit]

text: A month before the release, DreamWorks Animation CEO Jeffrey Katzenberg protested Warner Bros.' decision to convert Clash of the Titans from 2D to 3D, then to release it one week after How to Train Your Dragon.[11] Entertainment reporter Kim Masters described the 3D release schedule around March 2010 as a "traffic jam", and speculated that the lack of 3D screen availability could hurt Katzenberg's prospects despite his support of the 3D format.[12]

text: In March 2010, theater industry executives accused Paramount of using high-pressure tactics to coerce theaters to screen How to Train Your Dragon rather than the competing 3D releases, Clash of the Titans and Tim Burton's Alice in Wonderland. As theater multiplexes often had just one 3D screen, theaters were unable to accommodate more than one 3D presentation at a time.[13]

text: Box-office[edit]

text: How to Train Your Dragon topped the North American box office with $43.7 million in its first weekend of release.[14] The film grossed $217,581,231 in the United States and Canada and $277,297,528 in foreign countries with a worldwide total of $494,878,759.[1] How to Train Your Dragon is DreamWorks Animation's highest-grossing film in the American and Canadian box office other than the Shrek films.[15] It is the fifth-highest-grossing animated film of 2010 with $494.8 million, behind Toy Story 3 with $1,063.2 million, Shrek Forever After with $752.6 million, Tangled with $576.6 million, and Despicable Me with $543.1 million and the 10th-highest-grossing movie of 2010.[16]

text: Critical reception[edit]

text: How To Train Your Dragon received critical acclaim upon its release. Review aggregator Rotten Tomatoes reports that 98% of critics gave the film a positive review, based on 200 reviews from professional critics, with an overall rating average of 7.9 out of 10.[17] The site's general consensus is that, "Boasting dazzling animation, a script with surprising dramatic depth, and thrilling 3-D sequences, How to Train Your Dragon soars."[17] By "Tomatometer" score, the film is DreamWorks Animation's highest-rated film. On Metacritic, which assigns a weighted mean rating out of 0–100 reviews from film critics, the film has a rating score of 74 based on 33 reviews, indicating 'Generally favorable reviews.' [18] CinemaScore polls conducted during the opening weekend revealed the average grade cinemagoers gave How to Train Your Dragon was A on an A+ to F scale.[19]

text: Roger Ebert of The Chicago Sun-Times gave it 3 stars out of 4, stating that: "It devotes a great deal of time to aerial battles between tamed dragons and evil ones, and not much to character or story development. But it's bright, good-looking, and has high energy".[20] Claudia Puig of USA Today gave it 3.5 out of 4 stars, saying, "It's a thrilling action-adventure saga with exhilarating 3-D animation, a clever comedy with witty dialogue, a coming-of-age tale with surprising depth and a sweetly poignant tale of friendship between man and animal."[21] Rolling Stone film critic Peter Travers praised the film, giving it three out of four stars and in his print review wrote, "[The film] works enough miracles of 3-D animation to charm your socks off."[22] Roger Moore of The Orlando Sentinel, who gave the film 2½ stars out of 4, wrote a mixed review describing the film as a "more coming-of-age dramedy or 'everything about your world view is wrong' message movie than it is a comedy, and that seems like a waste of a funny book, some very funny actors and some darned witty animation."[23] Kyle Smith of the New York Post gave the film 2/4 stars labeling the film as, "Avatar for simpletons. But that title is already taken, by Avatar".[24] Contrarily, Brett Michel of The Boston Phoenix stated that the film was better than Avatar. A. O. Scott of At The Movies felt the characters and the story were not strong points, but loved the cinematography and said, "that swooping and soaring, they are worth the price of a ticket, so go see it."[25] Village Voice film critic Ella Taylor gave a more negative review of the film, describing it as an "adequate but unremarkable animated tale".[26] Film critic James Berardinelli of ReelViews praised the film and its story, giving it 3.5 out of 4 stars he wrote, "Technically proficient and featuring a witty, intelligent, surprisingly insightful script, How to Train Your Dragon comes close to the level of Pixar's recent output while easily exceeding the juvenilia DreamWorks has released in the last nine years."[27] Entertainment Weekly film critic Owen Gleiberman praised the film giving it an A- and wrote, "How to Train Your Dragon rouses you in conventional ways, but it's also the rare animated film that uses 3-D for its breathtaking spatial and emotional possibilities."[28] ViewLondon's Mathew Turner gave the film 4/5 stars, calling it, "beautifully animated and superbly written", and praised the voice cast, humor, and action. Matt Risley of Variety gave the film a perfect score of 5/5 stars, hailing it as, "undoubtedly Dreamworks' best film yet, and quite probably the best dragon movie ever made".

text: Accolades[edit]

text:
Awards

Award
Category
Name
Outcome

Academy Awards[29]
Academy Award for Best Animated Feature
Chris Sanders
Dean DeBlois
Nominated

Academy Award for Best Original Score
John Powell

Alliance of Women Film Journalists[30]
Best Animated Feature

Best Animated Female
America Ferrera (Astrid)
Won

Annie Awards[31][32]
Annie Award for Best Animated Feature
Bonnie Arnold
Chris Sanders
Dean DeBlois

Annie Award for Best Animated Effects in an Animated Production
Brett Miller

Jason Mayer
Nominated

Annie Award for Best Character Animation in a Feature Production
Gabe Hordos
Won

Jakob Hjort Jensen
Nominated

David Torres

Annie Award for Best Character Design in an Animated Feature Production
Nico Marlet
Won

Annie Award for Best Directing in an Animated Feature Production
Chris Sanders
Dean DeBlois

Annie Award for Best Music in an Animated Feature Production
John Powell

Annie Award for Production Design in an Animated Feature Production
Pierre-Olivier Vincent

Annie Award for Best Storyboarding in an Animated Feature Production
Tom Owens

Alessandro Carloni
Nominated

Annie Award for Best Voice Acting in an Animated Feature Production
Jay Baruchel (Hiccup)
Won

Gerard Butler (Stoick)
Nominated

Annie Award for Best Writing in an Animated Feature Production
William Davies
Chris Sanders
Dean DeBlois
Won

British Academy Film Awards[33]
BAFTA Award for Best Animated Film

Nominated

BAFTA Award for Best Film Music
John Powell

Chicago Film Critics Association Awards[34]
Best Animated Film
Chris Sanders
Dean DeBlois

Critics' Choice Awards[35]
Best Animated Feature Film

Genesis Awards[36]
Best Feature Film

Won

Golden Globe Awards[37]
Golden Globe Award for Best Animated Feature Film

Nominated

Golden Reel Awards[38]
Best Sound Editing in an Animated Feature Film

Won

International Film Music Critics Association[39][40]
Film Score of the Year
John Powell

Best Original Score for an Animated Feature
John Powell

Film Music Composition of the Year
John Powell – "Forbidden Friendship"
Nominated

John Powell – "Test Drive"

Kids' Choice Awards[41]
Favorite Animated Movie

Online Film Critics Society Awards[42]
Best Animated Feature
Chris Sanders
Dean DeBlois

People's Choice Awards[43]
Favorite Family Movie

Satellite Awards[44]
Motion Picture (Animated or Mixed)

Saturn Awards[45]
Saturn Award for Best Music
John Powell

Saturn Award for Best Production Design
Kathy Altieri

Saturn Award for Best Animated Film
Chris Sanders
Dean DeBlois

Teen Choice Awards[46]
Choice Animated Movie

Toronto Film Critics Association[47]
Toronto Film Critics Association Award for Best Animated Film

Won

Venice Film Festival[48]
Most Creative 3D Film of the Year
Chris Sanders and Dean DeBlois
Tied with James Cameron for Avatar

Visual Effects Society[49]
Visual Effects Society Award for Outstanding Animation in an Animated Feature Motion Picture
Simon Otto
Craig Ring
Bonnie Arnold

Visual Effects Society Award for Outstanding Animated Character in an Animated Feature Motion Picture
Gabe Hordos
Cassidy Curtis
Mariette Marinus
Brent Watkins

Visual Effects Society Award for Outstanding Effects Animation in an Animated Feature Motion Picture
Andy Hayes
Laurent Kermel
Jason Mayer
Brett Miller

Washington D.C. Area Film Critics Association Awards[50]
Best Animated Feature
Chris Sanders
Dean DeBlois
Nominated

World Soundtrack Academy[51]
World Soundtrack Award for Soundtrack Composer of the Year
John Powell

World Soundtrack Award for Best Original Song Written Directly for a Film
Jón Þór Birgisson

text: Home media[edit]

text: How to Train Your Dragon was released on single-disc DVD, two-disc double DVD pack and Blu-ray/DVD combo pack in Canada and the United States on Friday, October 15, 2010. Among the features available in the two-disc DVD edition is an original sequel short film, Legend of the Boneknapper Dragon. As of July 18, 2012, units sold for the DVD stand at more than 6.5 million copies and has grossed $121,663,692.[52]

text: Samsung signed a deal with DreamWorks to gain exclusive distribution rights to a Blu-ray 3D version of the film. The exclusive agreement ended on September 11, 2011, when How to Train Your Dragon - 3D was released in a two-disc Blu-ray combo pack.

text: It was re-released by Paramount Home Entertainment on Blu-ray and DVD on May 27, 2014.[53]

text: Expanded franchise[edit]

text: Sequels[edit]

text: A sequel, How to Train Your Dragon 2, was confirmed on April 27, 2010.[54] The film was directed and written by Dean DeBlois, the co-director of the first film. Bonnie Arnold, the producer of the first film, also returned.[55] The film was released on June 13, 2014 by 20th Century Fox, to critical acclaim.[56][57] The entire original voice cast—Baruchel, Butler, Ferguson, Ferrera, Hill, Mintz-Plasse, Miller,and Wiig—returned for the sequel[58] with the addition of Cate Blanchett, Djimon Hounsou, and Kit Harington.

text: A third film, How to Train Your Dragon 3, is in development. The film will also be directed and written by DeBlois, produced by Bonnie Arnold, and exec-produced by Chris Sanders, with all the main cast set to return. Cate Blanchett and Djimon Hounsou will also reprise their roles as Valka and Drago respectively from the second film.[59][60] It is scheduled to be released on March 1, 2019 by Universal Pictures.[61]

text: Short films[edit]

text: Four post-movie short films were released: Legend of the Boneknapper Dragon (2010), Book of Dragons (2011), Gift of the Night Fury (2011), and Dawn of the Dragon Racers (2014).[citation needed]

text: Television series[edit]

text: A television series based on the film premiered on Cartoon Network in Autumn 2012. Jay Baruchel, America Ferrera, Christopher Mintz-Plasse, and T. J. Miller reprise their roles as Hiccup, Astrid, Fishlegs, and Tuffnut. The series follows Hiccup and his friends as they learn more about dragons, discover new ones, teach others to feel comfortable around them, adapt traditions within the village to fit their new friends and battle against enemies as they explore new worlds. Hiccup has been made head of Berk Dragon Academy.[62]

text: Video games[edit]

text: An action adventure video game released by Activision, called How to Train Your Dragon, was released for the Wii, Xbox 360, PS3 and Nintendo DS gaming consoles. It is loosely based on the film and was released on March 23, 2010.

text: School of Dragons, a 3D free-to-play MMO, was released on July 17, 2013, at the San Diego Comic-Con.[63][64] The game is available for PC, Android and iOS.[65]

text: Arena show[edit]

text: How To Train Your Dragon Arena Spectacular is an arena show adaptation of the first film featuring 24 animatronic dragons, acrobats and projections. It premiered on March 2, 2012, in Melbourne, Australia.[66]


document_title: History of health care reform in the United States

question_text: who was the first u.s. president to propose a national health insurance plan

question_tokens: who was the first u.s. president to propose a national health insurance plan

text: History of health care reform in the United States

text: Federal health care proposals[edit]

text: 19th century[edit]

text: One of the earliest health care proposals at the federal level was the 1854 Bill for the Benefit of the Indigent Insane, which would have established asylums for the indigent insane, as well as the blind, and deaf via federal land grants to the states. This bill was proposed by activist Dorothea Dix and passed both houses of congress, but was vetoed by president Franklin Pierce. Pierce argued that the federal government should not commit itself to social welfare, which he stated was the responsibility of the states.[1][2]

text: After the Civil War, the federal government established the first system of medical care in the South, known as the Freedmen's Bureau. The government constructed 40 hospitals, employed over 120 physicians, and treated well over one million sick and dying former slaves. The hospitals were short lived, lasting from 1865 to 1870. Freedmen's Hospital in Washington, DC remained in operation until the late nineteenth century, when it became part of Howard University.[3]

text: The next major initiative came in the New Deal legislation of the 1930s, in the context of the Great Depression.[4]

text: In the first 10–15 years of the 20th century Progressivism was influencing both Europe and the United States.[5] Many European countries were passing the first social welfare acts and forming the basis for compulsory government-run or voluntary subsidized health care programs.[6] The United Kingdom passed the National Insurance Act of 1911 that provided medical care and replacement of some lost wages if a worker became ill. It did not, however, cover spouses or dependents. U.S. efforts to achieve universal coverage began with progressive health care reformers who supported Theodore Roosevelt for President in 1912, though he was defeated.[7] Progressives campaigned unsuccessfully for sickness insurance guaranteed by the states.[8] A unique American history of decentralization in government, limited government, and a tradition of classical liberalism are all possible explanations for the suspicion around the idea of compulsory government-run insurance.[6] The American Medical Association (AMA) was also deeply and vocally opposed to the idea,[8] which it labeled "socialized medicine". In addition, many urban US workers already had access to sickness insurance through employer-based sickness funds.

text: Early industrial sickness insurance purchased through employers was one influential economic origin of the current American health care system.[9] These late-19th-century and early-20th-century sickness insurance schemes were generally inexpensive for workers: their small scale and local administration kept overhead low, and because the people who purchased insurance were all employees of the same company, that prevented people who were already ill from buying in.[9] The presence of employer-based sickness funds may have contributed to why the idea of government-based insurance did not take hold in the United States at the same time that the United Kingdom and the rest of Europe was moving toward socialized schemes like the UK National Insurance Act of 1911.[9] Thus, at the beginning of the 20th century, Americans were used to associating insurance with employers, which paved the way for the beginning of third-party health insurance in the 1930s.

text: With the Great Depression, more and more people could not afford medical services. In 1933, Franklin D. Roosevelt asked Isidore Falk and Edgar Sydenstricter to help draft provisions to Roosevelt's pending Social Security legislation to include publicly funded health care programs. These reforms were attacked by the American Medical Association as well as state and local affiliates of the AMA as "compulsory health insurance." Roosevelt ended up removing the health care provisions from the bill in 1935. Fear of organized medicine's opposition to universal health care became standard for decades after the 1930s.[11]

text: During this time, individual hospitals began offering their own insurance programs, the first of which became Blue Cross.[12] Groups of hospitals as well as physician groups (i.e. Blue Shield) soon began selling group health insurance policies to employers, who then offered them to their employees and collected premiums. In the 1940s Congress passed legislation that supported the new third-party insurers. During World War II, Henry Kaiser used an arrangement in which doctors bypassed traditional fee-for-care and were contracted to meet all the medical needs for his employees on construction projects up and down the West coast.[13] After the war ended, he opened the plan up to the public as a non-profit organization under the name Kaiser Permanente.

text: During World War 2, the federal government introduced wages and price controls. In an effort to continue attracting and retaining employees without violating those controls, employers offered and sponsored health insurance to employees in lieu of gross pay. This was a beginning of the third-party paying system that began to replace direct out-of-pocket payments.

text: Following the world war, President Harry Truman called for universal health care as a part of his Fair Deal in 1949 but strong opposition stopped that part of the Fair Deal.[14][15] However, in 1946 the National Mental Health Act was passed, as was the Hospital Survey and Construction Act, or Hill-Burton Act. In 1951 the IRS declared group premiums paid by employers as a tax-deductible business expense,[6] which solidified the third-party insurance companies' place as primary providers of access to health care in the United States.

text: In the Civil Rights era of the 1960s and early 1970s, public opinion shifted towards the problem of the uninsured, especially the elderly. Since care for the elderly would someday affect everyone, supporters of health care reform were able to avoid the worst fears of "socialized medicine," which was considered a dirty word for its association with communism.[6] After Lyndon B. Johnson was elected president in 1964, the stage was set for the passage of Medicare and Medicaid in 1965.[16] Johnson's plan was not without opposition, however. "Opponents, especially the AMA and insurance companies, opposed the Johnson administration's proposal on the grounds that it was compulsory, it represented socialized medicine, it would reduce the quality of care, and it was 'un-American.'"[6] These views notwithstanding, the Medicare program was established by legislation signed into law on July 30, 1965, by President Lyndon B. Johnson. Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are either age 65 and over, or who meet other special criteria.

text: In 1970, three proposals for single-payer universal national health insurance financed by payroll taxes and general federal revenues were introduced in the U.S. Congress.[17] In February 1970, Representative Martha Griffiths (D-MI) introduced a national health insurance bill—without any cost sharing—developed with the AFL–CIO.[18] In April 1970, Senator Jacob Javits (R-NY) introduced a bill to extend Medicare to all—retaining existing Medicare cost sharing and coverage limits—developed after consultation with Governor Nelson Rockefeller (R-NY) and former Johnson administration HEW Secretary Wilbur Cohen.[19] In August 1970, Senator Ted Kennedy (D-MA) introduced a bipartisan national health insurance bill—without any cost sharing—developed with the Committee for National Health Insurance founded by United Auto Workers (UAW) president Walter Reuther, with a corresponding bill introduced in the House the following month by Representative James Corman (D-CA).[20] In September 1970, the Senate Labor and Public Welfare Committee held the first congressional hearings in twenty years on national health insurance.[21]

text: In January 1971, Kennedy began a decade as chairman of the Health subcommittee of the Senate Labor and Public Welfare Committee, and introduced a reconciled bipartisan Kennedy–Griffiths bill proposing universal national health insurance.[22] In February 1971, President Richard Nixon proposed more limited health insurance reform—an employer mandate to offer private health insurance if employees volunteered to pay 25 percent of premiums, federalization of Medicaid for the poor with dependent minor children, and support for health maintenance organizations (HMOs).[22] Hearings on national health insurance were held by the House Ways and Means Committee and the Senate Finance Committee in 1971, but no bill had the support of committee chairmen Representative Wilbur Mills (D-AR) or Senator Russell Long (D-LA).[22]

text: In October 1972, Nixon signed the Social Security Amendments of 1972 extending Medicare to those under 65 who have been severely disabled for over two years or have end stage renal disease (ESRD), and gradually raising the Medicare Part A payroll tax from 1.1% to 1.45% in 1986.[23] In November 1972, Nixon won re-election in a landslide over the only Democratic presidential nominee ever not endorsed by the AFL–CIO, Senator George McGovern (D-SD),[24] who was a cosponsor of the Kennedy-Griffiths bill, but did not make national health insurance a major issue in his campaign.[25]

text: In October 1973, Long and Senator Abraham Ribicoff (D-CT) introduced a bipartisan bill for catastrophic health insurance coverage for workers financed by payroll taxes and for Medicare beneficiaries, and federalization of Medicaid with extension to the poor without dependent minor children.[26] In February 1974, Nixon proposed more comprehensive health insurance reform—an employer mandate to offer private health insurance if employees volunteered to pay 25 percent of premiums, replacement of Medicaid by state-run health insurance plans available to all with income-based premiums and cost sharing, and replacement of Medicare with a new federal program that eliminated the limit on hospital days, added income-based out-of-pocket limits, and added outpatient prescription drug coverage.[27] In April 1974, Kennedy and Mills introduced a bill for near-universal national health insurance with benefits identical to the expanded Nixon plan—but with mandatory participation by employers and employees through payroll taxes and with lower cost sharing—both plans were criticized by labor, consumer, and senior citizens organizations because of their substantial cost sharing.[27]

text: In August 1974, after Nixon's resignation and President Gerald Ford's call for health insurance reform, Mills tried to advance a compromise based on Nixon's plan—but with mandatory participation by employers and employees through premiums to private health insurance companies and catastrophic health insurance coverage financed by payroll taxes—but gave up when unable to get more than a 13–12 majority of his committee to support his compromise plan.[27][28][29][30] In December 1974, Mills resigned as chairman of the Ways and Means Committee and was succeeded by Representative Al Ullman (D-OR), who opposed payroll tax and general federal revenue financing of national health insurance.[31]

text: In January 1975, in the midst of the worst recession in the four decades since the Great Depression, Ford said he would veto any health insurance reform,[32] and Kennedy returned to sponsoring his original universal national health insurance bill.[33] In April 1975, with one third of its sponsors gone after the November 1974 election,[34] the AMA replaced its "Medicredit" plan with an employer mandate proposal similar to Nixon's 1974 plan.[35] In January 1976, Ford proposed adding catastrophic coverage to Medicare, offset by increased cost sharing.[36] In April 1976, Democratic presidential candidate Jimmy Carter proposed health care reform that included key features of Kennedy's universal national health insurance bill.[37]

text: In December 1977, President Carter told Kennedy his bill must be changed to preserve a large role for private insurance companies, minimize federal spending (precluding payroll tax financing), and be phased-in so not to interfere with balancing the federal budget.[37][38] Kennedy and organized labor compromised and made the requested changes, but broke with Carter in July 1978 when he would not commit to pursuing a single bill with a fixed schedule for phasing-in comprehensive coverage.[37][38]

text: In May 1979, Kennedy proposed a new bipartisan universal national health insurance bill—choice of competing federally-regulated private health insurance plans with no cost sharing financed by income-based premiums via an employer mandate and individual mandate, replacement of Medicaid by government payment of premiums to private insurers, and enhancement of Medicare by adding prescription drug coverage and eliminating premiums and cost sharing.[39][40] In June 1979, Carter proposed more limited health insurance reform—an employer mandate to provide catastrophic private health insurance plus coverage without cost sharing for pregnant women and infants, federalization of Medicaid with extension to the very poor without dependent minor children, and enhancement of Medicare by adding catastrophic coverage.[39] In November 1979, Long led a bipartisan conservative majority of his Senate Finance Committee to support an employer mandate to provide catastrophic-only private health insurance and enhancement of Medicare by adding catastrophic coverage, but abandoned efforts in May 1980 due to budget constraints in the face of a deteriorating economy.[37][39][41][42]

text: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended the Employee Retirement Income Security Act of 1974 (ERISA) to give some employees the ability to continue health insurance coverage after leaving employment.

text: Clinton initiative[edit]

text: Health care reform was a major concern of the Bill Clinton administration headed up by First Lady Hillary Clinton. The 1993 Clinton health care plan included mandatory enrollment in a health insurance plan, subsidies to guarantee affordability across all income ranges, and the establishment of health alliances in each state. Every citizen or permanent resident would thus be guaranteed medical care. The bill faced withering criticism by Republicans, led by William Kristol, who communicated his concern that a Democratic health care bill would "revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government." [43] The bill was not enacted into law.

text: The "Health Security Express," a cross-country tour by multiple buses carrying supporters of President Clinton's national health care reform, started at the end of July 1994. During each stop, the bus riders would talk about their personal experiences, health care disasters and why they felt it was important for all Americans to have health insurance.[44]

text: Bush era debates[edit]

text: In 2000 the Health Insurance Association of America (HIAA) partnered with Families USA and the American Hospital Association (AHA) on a "strange bedfellows" proposal intended to seek common ground in expanding coverage for the uninsured.[45][46][47]

text: In 2001, a Patients' Bill of Rights was debated in Congress, which would have provided patients with an explicit list of rights concerning their health care. This initiative was essentially taking some of ideas found in the Consumers' Bill of Rights and applying it to the field of health care. It was undertaken in an effort to ensure the quality of care of all patients by preserving the integrity of the processes that occur in the health care industry.[48] Standardizing the nature of health care institutions in this manner proved rather provocative. In fact, many interest groups, including the American Medical Association (AMA) and the pharmaceutical industry came out vehemently against the congressional bill. Basically, providing emergency medical care to anyone, regardless of health insurance status, as well as the right of a patient to hold their health plan accountable for any and all harm done proved to be the biggest stumbling blocks for this bill.[48] As a result of this intense opposition, the Patients' Bill of Rights initiative eventually failed to pass Congress in 2002.

text: As president, Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act which included a prescription drug plan for elderly and disabled Americans.[49]

text: During the 2004 presidential election, both the George Bush and John Kerry campaigns offered health care proposals. Bush's proposals for expanding health care coverage were more modest than those advanced by Senator Kerry.[50][51][52] Several estimates were made comparing the cost and impact of the Bush and Kerry proposals. While the estimates varied, they all indicated that the increase in coverage and the funding requirements of the Bush plan would both be lower than those of the more comprehensive Kerry plan.[53][54]

text: In 2006 the HIAA's successor organization, America's Health Insurance Plans (AHIP), issued another set of reform proposals.[55]

text: In January 2007 Rep. John Conyers, Jr. (D-MI) has introduced The United States National Health Care Act (HR 676) in the House of Representatives. As of October 2008, HR 676 has 93 co-sponsors.[56] Also in January 2007, Senator Ron Wyden introduced the Healthy Americans Act (S. 334) in the Senate. As of October 2008, S. 334 had 17 cosponsors.[57]

text: Also in 2007, AHIP issued a proposal for guaranteeing access to coverage in the individual health insurance market and a proposal for improving the quality and safety of the U.S. health care system.[58][59]

text: "Economic Survey of the United States 2008: Health Care Reform" by the Organisation for Economic Co-operation and Development, published in December 2008, said that:[60]

text:
Tax benefits of employer-based insurances should be abolished.
The resulting tax revenues should be used to subsidize the purchase of insurance by individuals.
These subsidies, "which could take many forms, such as direct subsidies or refundable tax credits, would improve the current situation in at least two ways: they would reach those who do not now receive the benefit of the tax exclusion; and they would encourage more cost-conscious purchase of health insurance plans and health care services as, in contrast to the uncapped tax exclusion, such subsidies would reduce the incentive to purchase health plans with little cost sharing."

text: In December 2008, the Institute for America's Future, together with the chairman of the Ways and Means Health Subcommittee, Pete Stark, launched a proposal from Jacob Hacker, co-director of the U.C. Berkeley School of Law Center on Health, that in essence said that the government should offer a public health insurance plan to compete on a level playing field with private insurance plans.[61] This was said to be the basis of the Obama/Biden plan. The argument is based on three basic points. Firstly, public plans success at managing cost control (Medicare medical spending rose 4.6% p.a. compared 7.3% for private health insurance on a like-for-like basis in the 10 years from 1997 to 2006). Secondly, public insurance has better payment and quality-improvement methods because of its large databases, new payment approaches, and care-coordination strategies. Thirdly, it can set a standard against which private plans must compete, which would help unite the public around the principle of broadly shared risk while building greater confidence in government in the long term.[62]

text: Also in December 2008, America's Health Insurance Plans (AHIP) announced a set of proposals which included setting a national goal to reduce the projected growth in health care spending by 30%. AHIP said that if this goal were achieved, it would result in cumulative five-year savings of $500 billion. Among the proposals was the establishment of an independent comparative effectiveness entity that compares and evaluates the benefits, risks, and incremental costs of new drugs, devices, and biologics.[63] An earlier "Technical Memo" published by AHIP in June 2008 had estimated that a package of reforms involving comparative effectiveness research, health information technology (HIT), medical liability reform, "pay-for-performance" and disease management and prevention could reduce U.S. national health expenditures "by as much as 9 percent by the year 2025, compared with current baseline trends."[64]

text: Debate in the 2008 presidential election[edit]

text: Although both candidates had a health care system that revolved around private insurance markets with help from public insurance programs, both had different opinions on how this system should operate when put in place.[65]

text: Senator John McCain proposed a plan that focused on making health care more affordable. The senator proposed to replace special tax breaks for persons with employer-based health care coverage with a universal system of tax credits. These credits, $2,500 for an individual and $5,000 for a family would be available to Americans regardless of income, employment or tax liability. In his plan, Senator McCain proposed the Guaranteed Access Plan which would provide federal assistance to the states to secure health insurance coverage through high-risk areas.[66]

text: Senator McCain also proposed the idea of an open-market competition system. This would give families the opportunity to go across state lines and buy health plans, expanding personal options for affordable coverage and force the health insurance companies to compete over the consumers’ money on an unprecedented scale.[67]

text: Barack Obama called for universal health care. His health care plan called for the creation of a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance.

text: The Philadelphia Inquirer reported that the two plans had different philosophical focuses. They described the purpose of the McCain plan as to "make insurance more affordable," while the purpose of the Obama plan was for "more people to have health insurance."[68] The Des Moines Register characterized the plans similarly.[69]

text: A poll released in early November, 2008, found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it as fourth, tied with the war in Iraq. Affordability was the primary health care priority among both sets of voters. Obama voters were more likely than McCain voters to believe government can do much about health care costs.[70]

text: 2009 reform debate[edit]

text: In March 2009 AHIP proposed a set of reforms intended to address waste and unsustainable growth in the current health care market. These reforms included:

text:
An individual insurance mandate with a financial penalty as a quid pro quo for guaranteed issue
Updates to the Medicare physician fee schedule;
Setting standards and expectations for safety and quality of diagnostics;
Promoting care coordination and patient-centered care by designating a "medical home" that would replace fragmented care with a coordinated approach to care. Physicians would receive a periodic payment for a set of defined services, such as care coordination that integrates all treatment received by a patient throughout an illness or an acute event. This would promote ongoing comprehensive care management, optimizes patients’ health status and assist patients in navigating the health care system
Linking payment to quality, adherence to guidelines, achieving better clinical outcomes, giving better patient experience and lowering the total cost of care.
Bundled payments (instead of individual billing) for the management of chronic conditions in which providers would have shared accountability and responsibility for the management of chronic conditions such as coronary artery disease, diabetes, chronic obstructive pulmonary disease and asthma, and similarly
A fixed rate all-inclusive average payment for acute care episodes which tend to follow a pattern (even though some acute care episodes may cost more or less than this).[71]

text: On May 5, 2009, US Senate Finance Committee held hearings on Health care reform. On the panel of the "invited stakeholder", no supporter of the Single-payer health care system was invited.[72] The panel featured Republican senators and industry panelists who argued against any kind of expanded health care coverage.[73] The preclusion of the single payer option from the discussion caused significant protest by doctors in the audience.[73]

text: There is one bill currently before Congress but others are expected to be presented soon. A merged single bill is the likely outcome.[citation needed] The Affordable Health Choices Act is currently before the House of Representatives and the main sticking points at the markup stage of the bill have been in two areas; should the government provide a public insurance plan option to compete head to head with the private insurance sector, and secondly should comparative effectiveness research be used to contain costs met by the public providers of health care.[citation needed] Some Republicans have expressed opposition to the public insurance option believing that the government will not compete fairly with the private insurers. Republicans have also expressed opposition to the use of comparative effectiveness research to limit coverage in any public sector plan (including any public insurance scheme or any existing government scheme such as Medicare), which they regard as rationing by the back door.[citation needed] Democrats have claimed that the bill will not do this but are reluctant to introduce a clause that will prevent, arguing that it would limit the right of the DHHS to prevent payments for services that clearly do not work.[citation needed] America's Health Insurance Plans, the umbrella organization of the private health insurance providers in the United States has recently urged the use of CER to cut costs by restricting access to ineffective treatments and cost/benefit ineffective ones. Republican amendments to the bill would not prevent the private insurance sectors from citing CER to restrict coverage and apply rationing of their funds, a situation which would create a competition imbalance between the public and private sector insurers.[citation needed] A proposed but not yet enacted short bill with the same effect is the Republican sponsored Patients Act 2009.[citation needed]

text: On June 15, 2009, the U.S. Congressional Budget Office (CBO) issued a preliminary analysis of the major provisions of the Affordable Health Choices Act.[74] The CBO estimated the ten-year cost to the federal government of the major insurance-related provisions of the bill at approximately $1.0 trillion.[74] Over the same ten-year period from 2010 to 2019, the CBO estimated that the bill would reduce the number of uninsured Americans by approximately 16 million.[74] At about the same time, the Associated Press reported that the CBO had given Congressional officials an estimate of $1.6 trillion for the cost of a companion measure being developed by the Senate Finance Committee.[75] In response to these estimates, the Senate Finance Committee delayed action on its bill and began work on reducing the cost of the proposal to $1.0 trillion, and the debate over the Affordable Health Choices act became more acrimonious.[76][77] Congressional Democrats were surprised by the magnitude of the estimates, and the uncertainty created by the estimates has increased the confidence of Republicans who are critical of the Obama Administration's approach to health care.[78][79]

text: However, in a June New York Times editorial, economist Paul Krugman argued that despite these estimates universal health coverage is still affordable. "The fundamental fact is that we can afford universal health insurance—even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts."[80]

text: In contrast to earlier advocacy of a publicly funded health care program, in August 2009 Obama administration officials announced they would support a health insurance cooperative in response to deep political unrest amongst Congressional Republicans and amongst citizens in town hall meetings held across America.[81][82][83] However, in a June 2009 NBC News/Wall Street Journal survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance."[84]

text: During the summer of 2009, members of the "Tea Party" protested against proposed health care reforms.[85][86][87] Former insurance PR executive Wendell Potter of the Center for Media and Democracy- whose funding comes from groups such as the Tides Foundation-[88] argue that the hyperbole generated by this phenomenon is a form of corporate astroturfing, which he says that he used to write for CIGNA.[89] Opponents of more government involvement, such as Phil Kerpen of Americans for Prosperity- whose funding comes mainly from the Koch Industries corporation[90] counter-argue that those corporations oppose a public-plan, but some try to push for government actions that will unfairly benefit them, like employer mandates forcing private companies to buy health insurance.[91] Journalist Ben Smith has referred to mid-2009 as "The Summer of Astroturf" given the organizing and coordinating efforts made by various groups on both pro- and anti-reform sides.[87]

text: Healthcare debate, 2008–2010[edit]

text: Healthcare reform was a major topic of discussion during the 2008 Democratic presidential primaries. As the race narrowed, attention focused on the plans presented by the two leading candidates, New York Senator Hillary Clinton and the eventual nominee, Illinois Senator Barack Obama. Each candidate proposed a plan to cover the approximately 45 million Americans estimated to not have health insurance at some point each year. Clinton's plan would have required all Americans obtain coverage (in effect, an individual health insurance mandate), while Obama's provided a subsidy but did not include a mandate. During the general election, Obama said that fixing healthcare would be one of his top four priorities if he won the presidency.[92]

text: After his inauguration, Obama announced to a joint session of Congress in February 2009 his intent to work with Congress to construct a plan for healthcare reform.[93][94] By July, a series of bills were approved by committees within the House of Representatives.[95] On the Senate side, from June through to September, the Senate Finance Committee held a series of 31 meetings to develop of a healthcare reform bill. This group - in particular, Senators Max Baucus (D-MT), Chuck Grassley (R-IA), Kent Conrad (D-ND), Olympia Snowe (R-ME), Jeff Bingaman (D-NM), and Mike Enzi (R-WY) - met for more than 60 hours, and the principles that they discussed, in conjunction with the other Committees, became the foundation of the Senate's healthcare reform bill.[96][97][98]

text: With universal healthcare as one of the stated goals of the Obama Administration, Congressional Democrats and health policy experts like Jonathan Gruber and David Cutler argued that guaranteed issue would require both a community rating and an individual mandate to prevent either adverse selection and/or free riding from creating an insurance death spiral;[99] they convinced Obama that this was necessary, persuading him to accept Congressional proposals that included a mandate.[100] This approach was preferred because the President and Congressional leaders concluded that more liberal plans, such as Medicare-for-all, could not win filibuster-proof support in the Senate. By deliberately drawing on bipartisan ideas - the same basic outline was supported by former Senate Majority Leaders Howard Baker (R-TN), Bob Dole (R-KS), Tom Daschle (D-SD) and George Mitchell (D-ME) - the bill's drafters hoped to increase the chances of getting the necessary votes for passage.[101][102]

text: However, following the adoption of an individual mandate as a central component of the proposed reforms by Democrats, Republicans began to oppose the mandate and threaten to filibuster any bills that contained it.[103] Senate Minority Leader Mitch McConnell (R-KY), who lead the Republican Congressional strategy in responding to the bill, calculated that Republicans should not support the bill, and worked to keep party discipline and prevent defections:[104]

text:
“
It was absolutely critical that everybody be together because if the proponents of the bill were able to say it was bipartisan, it tended to convey to the public that this is O.K., they must have figured it out.[105]
”

text: Republican Senators, including those who had supported previous bills with a similar mandate, began to describe the mandate as "unconstitutional". Writing in The New Yorker, Ezra Klein stated that "the end result was... a policy that once enjoyed broad support within the Republican Party suddenly faced unified opposition."[106] The New York Times subsequently noted: "It can be difficult to remember now, given the ferocity with which many Republicans assail it as an attack on freedom, but the provision in President Obama's healthcare law requiring all Americans to buy health insurance has its roots in conservative thinking."[107][108]

text: The reform negotiations also attracted a great deal of attention from lobbyists,[109] including deals among certain lobbies and the advocates of the law to win the support of groups who had opposed past reform efforts, such as in 1993.[110][111] The Sunlight Foundation documented many of the reported ties between "the healthcare lobbyist complex" and politicians in both major parties.[112]

text: During the August 2009 summer congressional recess, many members went back to their districts and entertained town hall meetings to solicit public opinion on the proposals. Over the recess, the Tea Party movement organized protests and many conservative groups and individuals targeted congressional town hall meetings to voice their opposition to the proposed reform bills.[94] There were also many threats made against members of Congress over the course of the Congressional debate, and many were assigned extra protection.[113]

text: To maintain the progress of the legislative process, when Congress returned from recess, in September 2009 President Obama delivered a speech to a joint session of Congress supporting the ongoing Congressional negotiations, to re-emphasize his commitment to reform and again outline his proposals.[114] In it he acknowledged the polarization of the debate, and quoted a letter from the late-Senator Ted Kennedy urging on reform: "what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."[115] On November 7, the House of Representatives passed the Affordable Health Care for America Act on a 220–215 vote and forwarded it to the Senate for passage.[94]

text: Senate[edit]

text: The Senate began work on its own proposals while the House was still working on the Affordable Health Care for America Act. Instead, the Senate took up H.R. 3590, a bill regarding housing tax breaks for service members.[116] As the United States Constitution requires all revenue-related bills to originate in the House,[117] the Senate took up this bill since it was first passed by the House as a revenue-related modification to the Internal Revenue Code. The bill was then used as the Senate's vehicle for their healthcare reform proposal, completely revising the content of the bill.[118] The bill as amended would ultimately incorporate elements of proposals that were reported favorably by the Senate Health and Finance committees.

text: With the Republican minority in the Senate vowing to filibuster any bill that they did not support, requiring a cloture vote to end debate, 60 votes would be necessary to get passage in the Senate.[119] At the start of the 111th Congress, Democrats had only 58 votes; the Senate seat in Minnesota that would be won by Al Franken was still undergoing a recount, and Arlen Specter was still a Republican.

text: To reach 60 votes, negotiations were undertaken to satisfy the demands of moderate Democrats, and to try to bring aboard several Republican Senators; particular attention was given to Bob Bennett (R-UT), Chuck Grassley (R-IA), Mike Enzi (R-WY), and Olympia Snowe (R-ME). Negotiations continued even after July 7—when Al Franken was sworn into office, and by which time Arlen Specter had switched parties—because of disagreements over the substance of the bill, which was still being drafted in committee, and because moderate Democrats hoped to win bipartisan support. However, on August 25, before the bill could come up for a vote, Ted Kennedy—a long-time advocate for healthcare reform—died, depriving Democrats of their 60th vote. Before the seat was filled, attention was drawn to Senator Snowe because of her vote in favor of the draft bill in the Finance Committee on October 15, however she explicitly stated that this did not mean she would support the final bill.[99] Paul Kirk was appointed as Senator Kennedy's temporary replacement on September 24.

text: Following the Finance Committee vote, negotiations turned to the demands of moderate Democrats to finalize their support, whose votes would be necessary to break the Republican filibuster. Majority Leader Harry Reid focused on satisfying the centrist members of the Democratic caucus until the hold-outs narrowed down to Connecticut's Joe Lieberman, an independent who caucused with Democrats, and Nebraska's Ben Nelson. Lieberman, despite intense negotiations in search of a compromise by Reid, refused to support a public option; a concession granted only after Lieberman agreed to commit to voting for the bill if the provision was not included,[99][120] even though it had majority support in Congress.[121] There was debate among supporters of the bill about the importance of the public option,[122] although the vast majority of supporters concluded that it was a minor part of the reform overall,[120] and that Congressional Democrats' fight for it won various concessions; this included conditional waivers allowing states to set up state-based public options,[121] for example Vermont's Green Mountain Care.[123]

text: With every other Democrat now in favor and every other Republican now overtly opposed, the White House and Reid moved on to addressing Senator Nelson's concerns in order to win filibuster-proof support for the bill;[124] they had by this point concluded that "it was a waste of time dealing with [Snowe]"[125] because, after her vote for the draft bill in the Finance Committee, Snowe had come under intense pressure from the Republican Senate Leadership who opposed reform.[126] (Snowe retired at the end of her term, citing partisanship and polarization).[127] After a final 13-hour negotiation, Nelson's support for the bill was won after two concessions: a compromise on abortion, modifying the language of the bill "to give states the right to prohibit coverage of abortion within their own insurance exchanges," which would require consumers to pay for the procedure out-of-pocket if the state so decided; and an amendment to offer a higher rate of Medicaid reimbursement for Nebraska.[94][128] The latter half of the compromise was derisively referred to as the "Cornhusker Kickback"[129] and was later repealed by the subsequent reconciliation amendment bill.

text: On December 23, the Senate voted 60–39 to end debate on the bill: a cloture vote to end the filibuster by opponents. The bill then passed by a vote of 60–39 on December 24, 2009, with all Democrats and two independents voting for, and all Republicans voting against except one (Jim Bunning (R-KY), not voting).[130] The bill was endorsed by the AMA and AARP.[131]

text: Several weeks after the vote, on January 19, 2010, Massachusetts Republican Scott Brown was elected to the Senate in a special election to replace the late Ted Kennedy, having campaigned on giving the Republican minority the 41st vote needed to sustain filibusters, even signing autographs as "Scott 41."[94][132][133] The special election had become significant to the reform debate because of its effects on the legislative process. The first was a psychological one: the symbolic importance of losing the traditionally Democratic (‘blue’) Massachusetts seat formerly held by Ted Kennedy, a staunch support of reform, made many Congressional Democrats concerned about the political cost of passing a bill.[134][135] The second effect was more practical: the loss of the Democrat's supermajority complicated the legislative strategy of reform proponents.[135]

text: House[edit]

text: The election of Scott Brown meant Democrats could no longer break a filibuster in the Senate. In response, White House Chief of Staff Rahm Emanuel argued the Democrats should scale-back for a less ambitious bill; House Speaker Nancy Pelosi pushed back, dismissing Emanuel's scaled-down approach as "Kiddie Care."[136][137] Obama also remained insistent on comprehensive reform, and the news that Anthem Blue Cross in California intended to raise premium rates for its patients by as much as 39% gave him a new line of argument to reassure nervous Democrats after Scott Brown's win.[136][137] On February 22 Obama laid out a "Senate-leaning" proposal to consolidate the bills.[138] He also held a meeting, on February 25, with leaders of both parties urging passage of a reform bill.[94] The summit proved successful in shifting the political narrative away from the Massachusetts loss back to healthcare policy.[137]

text: With Democrats having lost a filibuster-proof supermajority in the Senate, but having already passed the Senate bill with 60 votes on December 24, the most viable option for the proponents of comprehensive reform was for the House to abandon its own health reform bill, the Affordable Health Care for America Act, and pass the Senate's bill, The Patient Protection and Affordable Care Act, instead. Various health policy experts encouraged the House to pass the Senate version of the bill.[139] However, House Democrats were not happy with the content of the Senate bill, and had expected to be able to negotiate changes in a House-Senate Conference before passing a final bill.[135] With that option off the table, as any bill that emerged from Conference that differed from the Senate bill would have to be passed in the Senate over another Republican filibuster; most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.[135] They drafted the Health Care and Education Reconciliation Act, which could be passed via the reconciliation process.[136][140][141] Unlike rules under regular order, as per the Congressional Budget Act of 1974 reconciliation cannot be subject to a filibuster, which requires 60 votes to break, but the process is limited to budget changes; this is why the procedure was never able to be used to pass a comprehensive reform bill in the first place, such as the ACA, due to inherently non-budgetary regulations.[142][143] Whereas the already passed Senate bill could not have been put through reconciliation, most of House Democrats' demands were budgetary: "these changes -- higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal -- mainly involve taxes and spending. In other words, they're exactly the kinds of policies that are well-suited for reconciliation."[140]

text: The remaining obstacle was a pivotal group of pro-life Democrats, initially reluctant to support the bill, led by Congressman Bart Stupak. The group found the possibility of federal funding for abortion would be substantive enough to warrant opposition. The Senate bill had not included language that satisfied their abortion concerns, but they could not include additional such language in the reconciliation bill, as it would be outside the scope of the process with its budgetary limits. Instead, President Obama issued Executive Order 13535, reaffirming the principles in the Hyde Amendment.[144] This concession won the support of Stupak and members of his group and assured passage of the bill.[141][145] The House passed the Senate bill with a vote of 219 to 212 on March 21, 2010, with 34 Democrats and all 178 Republicans voting against it.[146] The following day, Republicans introduced legislation to repeal the bill.[147] Obama signed the ACA into law on March 23, 2010.[148] The amendment bill, The Health Care and Education Reconciliation Act, was also passed by the House on March 21, then by the Senate via reconciliation on March 25, and finally signed by President Obama on March 30.

text: State and city reform efforts[edit]

text: A few states have taken steps toward universal health care coverage, most notably Minnesota, Massachusetts and Connecticut. Examples include the Massachusetts 2006 Health Reform Statute[149] and Connecticut's SustiNet plan to provide health care to state residents.[150] The influx of more than a quarter of a million newly insured residents has led to overcrowded waiting rooms and overworked primary-care physicians who were already in short supply in Massachusetts.[151] Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health care providers using what is generally characterized as a charity care scheme; New Jersey is an example of a state that employs the latter strategy.[citation needed]

text: Several single payer referendums have been proposed at the state level, but so far all have failed to pass: California in 1994,[152] Massachusetts in 2000, and Oregon in 2002.[153] The state legislature of California twice passed SB 840, The Health Care for All Californians Act, a single-payer health care system. Both times, Governor Arnold Schwarzenegger (R) vetoed the bill, once in 2006 and again in 2008.[154][155][156]

text: The percentage of residents that are uninsured varies from state to state. In 2008 Texas had the highest percentage of residents without health insurance, 24%.[157] New Mexico had the second highest percentage of uninsured that year at 22%.[157]

text: States play a variety of roles in the health care system including purchasers of health care and regulators of providers and health plans,[158] which give them multiple opportunities to try to improve how it functions. While states are actively working to improve the system in a variety of ways, there remains room for them to do more.[159]

text: One municipality, San Francisco, California, has established a program to provide health care to all uninsured residents (Healthy San Francisco).[citation needed]

text: In July 2009, Connecticut passed into law a plan called SustiNet, with the goal of achieving health care coverage of 98% of its residents by 2014.[150] The SustiNet law establishes a nine-member board to recommend to the legislature, by January 1, 2011, the details of and implementation process for a self-insured health care plan called SustiNet. The recommendations must address (1) the phased-in offering of the SustiNet plan to state employees and retirees, HUSKY A and B beneficiaries, people without employer-sponsored insurance (ESI) or with unaffordable ESI, small and large employers, and others; (2) establishing an entity that can contract with insurers and health care providers, set reimbursement rates, develop medical homes for patients, and encourage the use of health information technology; (3) a model benefits package; and (4) public outreach and ways to identify uninsured citizens.[160] The board must establish committees to make recommendations to it about health information technology, medical homes, clinical care and safety guidelines, and preventive care and improved health outcomes. The act also establishes an independent information clearinghouse to inform employers, consumers, and the public about SustiNet and private health care plans and creates task forces to address obesity, tobacco usage, and health care workforce issues. The effective date of the SustiNet law was July 1, 2009, for most provisions.[160]

text: In May 2011, the state of Vermont became the first state to pass legislation establishing a single-payer health care system. The legislation, known as Act 48, establishes health care in the state as a "human right" and lays the responsibility on the state to provide a health care system which best meets the needs of the citizens of Vermont. In December 2014, the governor of the state of Vermont suspended plans to implement this single-payer system because of its cost.[citation needed]