Lots of reasons, but chief among them:I don't understand how that happened. I don't follow politics closely at all but I thought the Dems had something like 2/3 of the seats in both House and Senate after the 2008 elections. With that kind of majority they should have been able to pass whatever they wanted to, even a single-payer plan, regardless of what the Republicans thought about it. What kept that from happening? How did we end up with this big complicated Act that nobody is really satisfied with?
- In the Senate they needed 60 votes. There were 60 Democrats/pseudoDemocrats until there was an election in Massachusetts (one of the more liberal states) and a Republican won (many people believe the election was decided by public reaction to the Bill and the shenanigans used to craft it. It was a precursor of the 2010 election). This put a big kink in any plans to modify the "awkward" bill that Democrats had already passed in the Senate.
- Not all the Democrats are liberal, and they needed a lot of them in both houses. To get the needed votes, a lot of ugly deals were struck.
The Republicans put forth many ideas and plans, but there's not much of that in the present law. What's there is almost solely the product of Democratic politicians. You are right--they controlled the House, the Senate and the Presidency.