The Health Security Act of 1993–94 had a great impact on the policy making that resulted in the Patient Protection and Affordable Care Act (PPACA) of 2010. In fact, many of President Barack Obama's advisers previously worked in President Bill Clinton's administration. Clinton's effort had failed, but Obama's was successful. Obama was determined not to repeat his predecessor's errors.
One reason for Obama's success was simply that healthcare in the US had become increasingly expensive during the fifteen-year interval. By Obama's presidency, the public was better informed about the need to overhaul healthcare. In 2007, Michael Moore's documentary, Sicko, appeared in theaters. In his film, Moore noted that the American healthcare system was ranked 37th in the world. Therefore, there was more public support for a major healthcare reform.
One problem with President Clinton's effort had been his wife's central and public role in it. Hillary was not too popular with broad segments of the population, and many questioned her credentials in the field of healthcare reform. Obama did not want to make his reform about him, so he stayed in the background.
In addition, Obama negotiated and was transparent. He worked with the healthcare insurance industry. Many observers believed Clinton's effort had been too secretive and uncooperative. Obama also made numerous concessions to his critics. For example, he gave up the public option. Because of his concessions, the PPACA was perhaps less far-reaching than it needed to be.
Although Obamacare became law, healthcare in the US remains extremely problematic because it is just too expensive for most Americans.