Wednesday marks the anniversary of the healthcare law that its advocates said would change so much. In one very real sense, they were right. The political landscape one year later is radically altered, strewn with the fallen congressional careers of many of its supporters.

The emotional debate over the bill arguably gave rise to the “tea party” movement. Republicans now control the House and aren’t far from seizing the Senate. Potential candidates for the 2012 GOP presidential nomination need only say one word, “Obamacare,” to get a rise from a crowd. And the president himself has struggled at times to ensure that his first term isn’t defined by the legislation.

Public attitudes toward the law, however, have not shifted much at all. The Affordable Care Act remains almost as equally loathed and celebrated as it was 12 months ago, despite the best efforts of Democrats to praise it and Republicans to bury it. Even worse for both sides, a majority of Americans remain confused about what the law actually accomplishes.

This week, the trench warfare has heated up once again. Democrats point to the tangible gains the legislation has already delivered, from lifting caps on lifetime benefits to prohibiting discrimination based on pre-existing medical conditions to helping seniors pay for prescription drugs, while saying even more lies ahead as the law’s provisions go fully into effect in coming years.


Republicans continue to pin the law to the sluggish economic recovery, dismissing Democratic arguments that the law won’t blow up the deficit, and maintaining that it has already hurt small business and lowered the quality of healthcare nationwide. In the meantime, the law’s most controversial aspect, its requirement that all Americans have health insurance, is under assault in the courts.

While public opinion has stayed relatively static on the act, there’s no doubt that the GOP still senses a political opportunity. For much of the last year, Democrats have sat on their heels on the issue; most incumbents ran as far away from the as possible during the congressional midterms. The ones that remain in Congress have witnessed Republicans vote to repeal the law in the House and muster a fair share of votes to do so in the Senate — and the GOP says it’s committed to using the appropriations process to gut the law.

On the putative Republican presidential campaign trail, targeting the healthcare law remains a favorite sport. Repeal is an article of faith among tea-partiers and budget hawks. Candidates such as Tim Pawlenty are seeking to use the law’s persistent unpopularity to boost their profiles, while Mitt Romney’s prospects remain fogged because of his support of a similar law while he governed Massachusetts.

“If courts do not do so first, as president, I would support the immediate repeal of Obamacare and replace it with market-based healthcare reforms,” Pawlenty said in a statement Wednesday.


But according to polls, advocating a full-blown repeal also carries political risk. According to a new survey from the Kaiser Family Foundation, fewer than 40 percent of Americans favor repeal, regardless of whether the Republicans replace it with an alternative. That suggests that while agitating against the law plays well to the GOP base, it risks alienating centrist voters who may be taking more of a wait-and-see approach to the act.

Some in the Republican Party have recognized that certain provisions, such as ensuring that people—especially children—with pre-existing medical conditions can find health insurance, play well with the electorate and have suggested that a GOP plan would accomplish the same at less cost through the use of purchasing pools and other market-based reforms.

GOP leaders are still working up a replacement in the House. “We don’t accept the status quo,” Rep. Tom Price of Georgia said on Wednesday. “There are a lot of things that need to be improved upon.”

Price said he saw little risk in repeal, saying his constituents are more ardent about doing away with the law than ever.


A more recent Republican line of attack has been the hundreds of waivers the Obama administration has issued to businesses, unions and states, exempting them from complying with the law at least until 2014, when the new state-based insurance exchanges are supposed to begin operating.

“Every waiver that occurs brings life to the fact that this bill is unworkable,” Price said.

The GOP political action group Crossroads GPS announced Wednesday that it was suing the Department of Health and Human Services for information on the administration’s waiver process.

Democrats argued Wednesday that the GOP isn’t focused on the economy — the same charge Republicans leveled against them when the law was being debated.


“Republicans are continuing to refight the political battles of the past while the American public is ready to move on,” said Rep. Debbie Wasserman-Schultz of Florida. She said repeal would be “catastrophic.”

Healthcare reform advocacy groups such as Health Care for America Now are sponsoring some 200 events this week in 35 states to highlight the benefits of the legislation, including one in Harrisburg, Pa., on Wednesday that will be attended by Health and Human Services Secretary Kathleen Sebelius.

But the White House and Democratic leaders on the Hill have been relatively quiet in their defense of the law on its one-year anniversary, leaving the heavy lifting to advocacy groups. The White House did release a video in which the president called a Michigan college student who will be able to stay on his mother’s health insurance plan as a result of the act.

Republicans say they will continue to push the Democratic-controlled Senate on repeal efforts. Price said that with 23 Democrats in that chamber up for reelection next year—many of them from swing states—momentum may build next year for action, he said.


“We may get a critical mass at some point and actually be able to move something,” he said, adding that he expected the Supreme Court to declare part of the law unconstitutional next year regardless.

james.oliphant@latimes.com