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Obamacare at age 3: Why political battles are exploding anew

Partisan rancor over Obamacare is back amid public confusion over what the law does. But with some Republican governors agreeing to expand Medicaid, the law in time could take on a more bipartisan complexion.

By Staff writer / March 23, 2013

A draft copy of the 21-page Health and Human Services Department form proposed for use in applying for low-cost insurance from Medicaid or the Children's Health Insurance Program.

J. David Ake/AP

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Washington

On March 23, 2010, amid much fanfare, President Obama signed the Affordable Care Act – a law aimed at taking the nation a long way toward universal health-care coverage.  

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Three years later, “Obamacare” remains a work in progress. At least 13 states have opted not to accept federal money to expand access to Medicaid, federal health insurance for the poor, after the Supreme Court’s ruling last June that made participation in the expansion of Medicaid optional.

And about half the states are declining to set up electronic health-insurance markets, or “exchanges” that provide consumers with health-insurance options, leaving the federal government to do it for them.

The mixed approach by the states, combined with continuing strong opposition to the law by congressional Republicans, has left some Democrats frustrated.

“You’re already seeing the propaganda machine on the Republican side gearing up stories about how Obamacare is going to be a failure,” said Rep. Chris Van Hollen (D) of Maryland, speaking at a breakfast with reporters Friday sponsored by Third Way, a Democratic think tank. “From a political perspective it’s important that the White House be ready to counter a lot of these false claims.”

Public confusion about the law remains high, and has even worsened since it was enacted. A Kaiser Family Foundation poll found that 57 percent of Americans say they don’t know enough about the law to judge how it will affect them personally. Among the uninsured who are under age 65, the figure is 67 percent. Among those with household income under $40,000, it’s 68 percent.

Forty percent of those surveyed had an unfavorable view of the law, 37 percent had a favorable view, and 23 percent had no opinion.

“Though opinion on the law overall remains nearly evenly divided, opponents’ attacks seem to have taken a toll on the public’s expectations,” the Kaiser report says.

In addition, Americans are now likely to think the law will make things worse for their families rather than better.

So when the exchanges begin open enrollment on Oct. 1, it’s unclear how widely the uninsured will respond. The law includes an individual mandate to purchase insurance, effective Jan. 1, 2014, but in the first year, the penalty for noncompliance is as little as $95. If most healthy uninsured people opt to pay the penalty rather than buy insurance, that would produce a risk pool weighted toward people with expensive medical bills – an unhappy outcome for insurers.

The political debate has also reignited.

Congressman Van Hollen, the ranking Democrat on the House Budget Committee, cites as an example of “false claims” about Obamacare assertions that the law has caused a spike in health-care premiums.

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