Senate Majority Leader Harry M. Reid secured the pivotal vote in the Senate at 1:17 am on Dec. 21 by buying enough votes to pass the bill. This was not an example of a Constitutional Democracy in which the Senators voted the will of the people, but an example of open corruption that makes the already tottering federal government look more illegitimate. The constitutionality of the bill has been questioned as never before have US citizens been forced to buy a product because they are citizens.
One of the methods of insuring additional people will be through the expansion of Medicaid and those states that held out will get assistance from other states to pay it:
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