Passed in 2010, the Affordable Care Act is colloquially known as “Obamacare.” This healthcare legislation changed the insurance industry by requiring insurance companies to cover pre-existing conditions and preventative healthcare. It also made provisions for states to expand Medicaid coverage to working-class people who could not otherwise afford insurance. 

In the book, Pelosi represents work on the law as what collaborative legislation looks like in practice. She believes its passage marks one of the great achievements of her tenure as speaker. Pelosi does acknowledge that Republican opposition to the bill supercharged a more vitriolic political discourse and led to Democratic losses in Congress.

A 2010 Supreme Court decision, Citizens United v. FEC is a case that effectively allowed corporations and groups to spend large amounts of money on campaigns related to legislation and elections. The court based its decision on the idea that money represents freedom of speech and thus should not be limited in political settings. The decision injected large sums of dark money—political donations with sourcing that is not always transparent—into the political process. Groups known as super PACs (political action committees) were allowed to funnel money to their preferred causes and candidates. 

Pelosi believes Citizens United led to greater power for corporations and the wealthy in the political process.