Wednesday marks a year since President Obama signed the Patient Protection and Affordable Care Act into law.
But in those ensuing 12 months, the debate has barely missed a beat.
On Capitol Hill, Democrats have continued to sing the measure's praises.
"With this landmark law, we made health insurance and health care a right, not a privilege, for all Americans," said House Democratic leader Nancy Pelosi, "by extending coverage to 32 million more Americans."
Meanwhile, Republicans, like Utah Sen. Orrin Hatch, have been considerably more downbeat. "I hate to talk this way, but it's true: It is one of the worst pieces of legislation in the history of this country," Hatch said on the PBS NewsHour. "And it's not going to work."
Will The Law Take Root?
Sowing seeds of doubt about the law is all part of opponents' strategy, says Michael Cannon, director of health policy studies for the libertarian Cato Institute.
"I think this really is a race between those who want this law to take root and those who want to prevent this law from taking root," Cannon said.
At the moment, with Democrats still in control of the Senate and presidency, opponents know they can't actually get much accomplished substantively.
"So if you want a legislative fix to Obamacare — if you want to repeal it — you have to keep it unpopular between now and January of 2013, when you get a new Congress and maybe a new president," Cannon says. "And what that means is you try to keep the law from taking root, and you try to educate the public about all its harmful effects between now and Election Day 2012. That's what opponents of the law are focused on doing right now."
Meaning forcing all those otherwise symbolic votes to repeal or defund the law, as well as the dozens of lawsuits challenging the law's Constitutionality.
Cementing A Constituency
Supporters of the law, on the other hand, want to pursue exactly the opposite strategy: sink those roots in so deep as to make the law unrepealable.
"Certainly, when the law begins spending hundreds of billions of dollars on health insurance subsidies to low- and middle-income Americans, you're going to be creating a huge constituency that will fight to preserve it," says Cannon.
Ron Pollack of Families USA, which strongly backs the law, says that as the public sees more of the law's benefits, support for it will grow. But he insists it's about more than just buying off individual constituencies. It's about what the law actually does for people.
"Those people who have pre-existing conditions, they don't want to be denied coverage by insurance companies," Pollack says. "When people get sick, they don't want to lose the health coverage they've been paying for for many years."
Establishing Health Exchanges
Pollack says supporters of the law are also still fighting to help the public understand the 2,000-plus-page measure. "There are so many myths about this legislation — from death panels, government takeover, that this is adding to the deficit," he says. "None of those things are true."
Health law opponent Cannon, meanwhile, is worried that many Republican governors who oppose the law are undercutting their arguments by working with the Obama administration to set up the new insurance marketplaces known as health exchanges.
"Governors should not be taking the funds that are available under this law and not setting up those new government bureaucracies," he says, "because that further entrenches the law."
In other words, on the law's first birthday, it's still one big race — a competition between supporters who hope the health law will have many more birthdays to celebrate, and opponents who'd like to blow out the candles. Permanently.
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