Congress had tried to hammer together a national health-care initiative for a century, but it wasn't until a woman ascended to a key position of power in Washington that a plan actually passed.
This is not a mere historical coincidence. Sure, President Obama pushed health-care reform to the top of the country's agenda, and the Democratic majorities in the House and the Senate were essential to passing the bill. But make no mistake: The overhaul happened because Nancy Pelosi wanted it to happen, deep in her DNA.
This wasn't just another piece of legislation for Pelosi -- this was the culmination of a crusade she has been waging her entire career to reorder Washington's priorities. Pelosi's animating ambition has been to put so-called women's and family issues such as health care, education and the welfare of children on the same level as homeland security, foreign relations and defense.
The tenacity with which she fought for health-care reform is directly tied to her gender. The belief that women, and the agendas they tend to support, are underrepresented has provided much of the rocket fuel that propelled her rise through Congress over 22 years. In 1984, Pelosi ran for the Democratic Party's national chairmanship and lost; party leaders told her she would have won if she had been a man. Since then, the Californian has been on a mission to smash the old-boy network in Washington.
When Pelosi made expanding health care one of her top priorities, friends and colleagues say it was, without question, because she is a woman and a mother.
'It's personal for women,' Pelosi announced on the House floor during final arguments on the health-care bill March 21. In an interview the next day, she said, 'My sisters here in the Congress, this was a big issue for us.'
Pelosi said her fellow 'caregivers' had a lot invested in reform, since they are the ones who provide most of the health care for their families and are acutely aware of problems in the system.
And on the House floor, she said, 'After we pass this bill, being a woman will no longer be a preexisting medical condition.' In a recent roundtable discussion, Pelosi explained that insurance companies charge women higher premiums than men by 'gender rating' conditions such as giving birth, having a C-section or being a victim of domestic violence. These 'preexisting conditions' also allowed the companies to refuse coverage; they can't do that anymore.
Because improving health care was a sacred cause to Pelosi, she had the backbone to stick with it at critical points along the way. After Republican Scott Brown won Ted Kennedy's old Senate seat from Massachusetts with a promise to thwart the health-care bill, Pelosi was the only leader who didn't blink. According to published reports, when President Obama was contemplating a compromise with Republicans, and White House Chief of Staff Rahm Emanuel and Senate Majority Leader Harry Reid (D-Nev.) were advocating a less-ambitious measure (which Pelosi derided as 'kiddie-care,') she persuaded them to stick with an omnibus bill.
When other congressional leaders and the White House were scrambling for votes in the final days of debate, and Rep. Bart Stupak (D-Mich.) demanded a ban on public funding for abortions in exchange for his support, Pelosi stood firm. She promised that there would be no health-care bill if it included the Stupak language. Instead, Obama issued a presidential order affirming the existing prohibition on federal abortion funding.
And it was Pelosi who personally rounded up votes time and again, keeping her Democratic caucus unified enough to get more than the 216 ayes she needed.
Passing such a controversial law required raw political savvy. And Pelosi learned much of it managing the 'favor file' for her father, Thomas D'Alesandro Jr., the longtime mayor of Baltimore, and during years of rough-and-tumble politics that had nothing to do with gender. But even Pelosi believes her vote-gathering and coalition-building skills represent a new, more collaborative way of doing business in Congress.
'I do think that, I'm not saying this is a female trait, but I am a good listener,' Pelosi said in an interview shortly after she became speaker in 2007. '. . . I do try to have decisions made in a collegial way. Listening and talking it through rather than just deciding how something will be or conducting a meeting in a way that doesn't elicit honest response.'
'It's such a male-dominated institution,' she added. 'It's sort of a pecking order that goes back over 200 years. All of a sudden you're saying, 'Wait a minute, I have another idea about how this should be.' '
If there's a hallmark of Pelosi's leadership style, it's an abundance of meetings. She practices a kind of shuttle diplomacy via endless one-one-one conversations in her office and the halls of the Capitol and a stream of after-hours phone calls, keeping everyone in the loop.
Pelosi believes in the 'psychology of consensus,' explained House Majority Leader Steny Hoyer (D-Md.), her second-in-command. 'She is a politician and a leader who understands if you are going to be successful, it is because you create agreement, not just to make points.'
Some say that consensus-building approach to leadership comes more naturally to women.
'Women tend to be more collaborative, no question,' said Ellen Malcolm, chief of Emily's List, a group that helps fund female political candidates. 'I don't think that's a stereotype. I think women in general look for ways to bring people together and are less likely to say 'It's my way or the highway' and 'I'm going to prove to you.' '
Previous speakers and majority leaders such as Tom 'the Hammer' DeLay (R-Tex.) often governed by force and intimidation or sheer machismo -- 'the alpha-male-silverback strategy,' argues University of California at Berkeley professor Robin Lakoff, who has written several books on gender and its impact on language and politics. While that tack often produces the desired results, it can also lead to resentments.
Of course, Pelosi's emphasis on consensus doesn't reach much beyond her party. Repairing individual relationships with congressional Republicans has never been her priority. Pelosi is a partisan warrior: The unity of her caucus has always been more important to her than bipartisanship. She believes it's her job to build the confidence of Democrats, keep them believing in their core principles and constantly remind them that those principles are worth fighting for.
Pelosi's success in elevating health care and other 'women's' issues seems to be emboldening other women to take up the fight as well. In the final, crucial days of debate, Roman Catholic nuns broke with the Vatican and announced their support for health-care reform, defying their church's hierarchy to add their voices to Pelosi's.
And the speaker's receptiveness to so-called family and women's issues has opened the floodgates for other such bills. More than 1,000 bills and resolutions were introduced in Pelosi's first session regarding issues that have a direct impact on women, and a majority of those were introduced by female lawmakers.
It's probably no coincidence that the United States, the last of the world's industrialized countries to adopt a comprehensive health-care blueprint, also ranks at the bottom among those countries in the gender equity of its political bodies.
'We have cut the human issues out, and left those to women and called them women's issues,' said Marie Wilson, founder of the White House Project, which encourages women to run for higher office. Wilson is hopeful, though, that Pelosi's success will prod male legislators to focus more on 'the human issues' as well. 'When women are alongside men,' she said, 'men are more likely to do things they need to do without being seen as sissies.'