Despite three years of political rancor, Republicans have largely failed to score a substantive win over President Obama’s healthcare law — and the November elections might be their last chance.

Healthcare reform has been declared dead countless times since Obama first began the legislative push in 2009. The latest near-death experience came from the Supreme Court, which even many Democrats expected would strike down the healthcare law last week.

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But, once, again, healthcare reform survived.

Chief Justice John Roberts cast the deciding vote in a 5-4 decision upholding the Affordable Care Act. The ruling dashed Republican hopes that the court would spare them from the messy politics of repealing the law’s popular provisions. And it was the highest-profile victory yet for a law that has proven remarkably resilient in the face of blistering attacks and entrenched opposition.

After so many failed attempts to kill the Affordable Care Act, Republicans now acknowledge that November is probably their last chance.

“That’s the last train that’s leaving the station in regard to stopping this,” Rep. Phil Gingrey John (Phil) Phillip GingreyEx-Tea Party lawmakers turn heads on K Street 2017's top health care stories, from ObamaCare to opioids Beating the drum on healthcare MORE (R-Ga.) said. “This train is leaving the station, and there’s not going to be another opportunity. If Barack Obama Barack Hussein ObamaJudge orders Georgia officials to provide backup paper poll books ahead of election Supreme Court fight should drive Democrats and help Biden Michelle Obama says even former first families can get on each other's nerves during quarantine MORE is reelected to a second term, and we don’t replace him with the 45th president, then this law sinks in, it gets roots, and it ain’t going away.”

The White House and congressional Democrats say the Supreme Court’s decision should put to rest the years-long controversy over healthcare, effectively settling the debate.

"The highest court in the land has now spoken," Obama said last Thursday. "We will continue to implement this law and we'll work together to improve on it where we can. But what we won't do — what the country can't afford to do — is refight the political battles of two years ago, or go back to the way things were.

"It passed Congress, was signed by the president and was ruled constitutional by the Supreme Court," a former senior administration official said. "What more do they want? Time to give it up before they just look silly."

Republicans, though, say the court’s ruling will fire up their base and energize conservatives ahead of Election Day. So far, it has — Mitt Romney’s presidential campaign raised an eye-popping $5.5 million from 55,000 donations in the immediate wake of the decision.

"We're not deterred," Rep. Paul Ryan Paul Davis RyanTrump, Biden have one debate goal: Don't lose RNC chair on election: We are on track to win the White House Kenosha will be a good bellwether in 2020 MORE (R-Wis.) said on ABC’s "This Week" on Sunday. "We think we can still repeal this law if we win this election. The American people will be the judge and jury on this law come November."

But this is hardly the first time Republicans have seized a political moment to try to stop “ObamaCare,” and for all the attention that angry Tea Party voters get, the law is still standing.

The GOP seemed to have a very real shot at killing healthcare reform in the summer of 2009, when negotiations led by Sen. Max Baucus Max Sieben BaucusBottom line Bottom line The Hill's Morning Report - Presented by Facebook - George Floyd's death sparks protests, National Guard activation MORE (D-Mont.) failed to yield bipartisan agreement and incendiary attacks about “death panels” helped fuel angry town-hall protests. Sen. Jim DeMint (R-S.C.) said the effort would be Obama’s “Waterloo.”

Healthcare was declared dead again in January 2010, when Republican Scott Brown won the special election for the late Sen. Edward Kennedy’s (D-Mass.) seat, putting an end to Democrats' filibuster-proof majority.

Two months later, Obama signed the Affordable Care Act into law, after maneuvering around abortion-related controversies that had again threatened to derail the effort.

A wave of conservative anger over healthcare helped propel Republicans into the House majority in 2010. They pledged to try to repeal controversial parts of the law, but Congress has only removed minor provisions dealing with tax filings and income calculations.

Republicans also pledged to cut off funding to implement the law, but it has not fared much worse than other programs in a time of deep, across-the-board budget-cutting.

In fact, the biggest wound the Affordable Care Act has suffered was self-inflicted. The law’s CLASS program, designed to provide insurance for long-term care, was unworkable as written and the Health and Human Services Department gave up trying to implement it. About half of the law’s deficit reduction went out the window.

November will give Republicans one last shot.

Rep. Bill Cassidy (R-La.), who is a doctor, said the law will, if implemented fully, cause problems that Congress will have to fix. But the upcoming elections could represent the last chance to score a political victory against the law.

“In terms of stopping it politically, of course, if President Obama is reelected, the taxes, the intrusion of government upon our lives, the loss of jobs at small businesses, will be the law of the land,” Cassidy said.

Repealing the law would likely prove more difficult than Romney makes it sound on the campaign trail. Republicans would need to win a 60-seat majority in the Senate to cleanly pass repeal and avoid the procedural mess of trying to use budget reconciliation.

Still, while Democrats say the debate ought to be over, they acknowledge Republican gains in November pose a legitimate threat to the signature domestic achievement of Obama and Democratic Leader Nancy Pelosi (D-Calif.).

“A lot will depend on who the president’s going to be,” Rep. Henry Waxman (D-Calif.) said. “If Romney becomes president and has a Republican Congress, they can certainly do a lot to repeal it or weaken it, and so there’s still a vulnerability for this law.”



