The context here was amidst the push for Clinton's health reform plan. Pelosi wanted to push the bill to the left. Instead no agreement could be reached and nothing passed. Democrats lost both houses of Congress in historic wipeout later that year https://twitter.com/lhfang/status/1341867268196560897

By 2009 Pelosi was Speaker. Dems had regained Congress and the presidency for first time in 14 years.

Now she was the leader, trying to focus on what she could pass. (The person demanding a vote on single-payer that year was Anthony Weiner.)

https://thehill.com/homenews/house/66721-pelosi-no-house-vote-on-single-payer-plan

Obamacare did pass but Dems had another historic wipeout in the 2010 midterms and this time lost the House for what turned out to be 8 years.

Pelosi's more cautious approach in her second Speaker stint has surely been shaped by this experience of 8 long years in the minority.

The strategy of '09-'10 — compromises, deals with industry — was also based on Democrats' assessment that they failed to appease powerful interests in '94, and those powerful interests then fomented a backlash that killed the bill (and helped sink Dems in Congress).

Of course in '09-'10 the backlash ended up coming anyway, despite the deals. And Dems did get wiped out in the House.

But the bill did pass.

Obamacare fell short of the left's dreams in many ways but hard to argue that we'd be in a better place now if it had never passed. (Unless you're a heighten-the-contradictions person.)

Its Medicaid expansion especially has been a huge help to millions https://www.vox.com/2020/8/26/21403086/covid-19-coronavirus-obamacare-medicaid-health-insurance