As the Great RecessionGreat Recession began and medical costs climbed in 2008, each party’s presidential candidates proposed health care reform. Although the public supported changes to the American health care system, every attempt to pass universal health care over the previous century failed. The deals made by the ObamaObama, Barack administration with the health industry in the early months of negotiations fixed dimensionality of the Democratic proposals on insurance access over cost control, which not only pleased health care groups but also legislators with close connections to those groups. By dropping some cost-control measures like the public optionpublic option, negotiators secured pivotal votes and passed legislation expanding insurance access. Building coalitions to pass health care reform required multiple instances of strategic votingstrategic voting and dimension manipulation. After the surprising victory by Republican Scott BrownScott Brown in a Senate special election, Democrats resorted to budget reconciliationbudget reconciliation, thereby fixing dimensionalitydimension manipulationfixing dimensionality on the Senate’s bill. In an act of strategic voting, the House agreed to pass the Senate’s bill in return for more progressive elements contained in the “Sidecar Bill.” Democrats passed the Affordable Care Act not because it was their ideal health care bill, but because it was the bill they could pass.