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Unlike rules under regular order, as per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. However, the process is limited to budget changes, which is why the procedure was never able to be used to pass a comprehensive reform bill like the ACA in the first place; such a bill would have inherently non-budgetary regulations.[113][114] 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."[111]
The remaining obstacle was a pivotal group of pro-life Democrats led by Bart Stupak who were initially reluctant to support the bill. The group found the possibility of federal funding for abortion 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.[115] This concession won the support of Stupak and members of his group and assured passage of the bill.[112][116] The House passed the Senate bill with a 219–212 vote on March 21, 2010, with 34 Democrats and all 178 Republicans voting against it.[117] The following day, Republicans introduced legislation to repeal the bill.[118] Obama signed the ACA into law on March 23, 2010.[119] The amendment bill, The Health Care and Education Reconciliation Act, was also passed by the House on March 21, by the Senate via reconciliation on March 25, and was signed by President Obama on March 30.
