When the ACA was signed into law in 2010, it was the first federal legislation in history that was designed to achieve universal health insurance for all U.S. citizens and legal residents, despite the fact that multiple attempts at universal health insurance coverage had been on the political agenda of presidential administrations going back to Theodore Roosevelt (19011909). Whether not the ACA is implemented as originally signed into law, its passage through Congress is a historically anomaly. Why did the Obama administration succeed with the ACA where other presidential administrations throughout history had failed?