STEVE INSKEEP, Host:
It's MORNING EDITION from NPR News. I'm Steve Inskeep.
One year ago today, President Obama signed into law the most sweeping piece of social legislation in more than a generation.
BARACK OBAMA: Today, after all the votes have been tallied, health insurance reform becomes law in the United States of America.
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INSKEEP: But turning the health bill into law did not settle the debate. As NPR's Julie Rovner reports, it's merely changed the terms.
JULIE ROVNER: In case you've forgotten, the health law was intended to dramatically change the direction of the health care system. It will require nearly every American to have health insurance by the year 2014. But it will also provide substantial help for those who can't otherwise afford it.
As the law's first anniversary approached, supporters like House Democratic leader Nancy Pelosi scheduled events to sing its praises.
NANCY PELOSI: With this landmark law, we made health insurance and health care a right, not a privilege, by extending coverage to 32 million more Americans.
ROVNER: Meanwhile, opponents, like Utah Republican Senator Orrin Hatch, here on the "PBS NewsHour," have been considerably more downbeat.
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ORRIN HATCH: 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.
ROVNER: In fact, sowing seeds of doubt about the law is all part of opponents' strategy, says Michael Cannon, head of health policy for the libertarian Cato Institute. That's because at the moment, with Democrats still in control of the Senate and presidency, opponents know they can't actually do much to change the law.
MICHAEL CANNON: 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.
ROVNER: That's the soonest Republicans could gain enough control to make the law go away. So what needs to happen between now and then?
CANNON: You try to keep the law from taking root, and you try to educate the public about all its harmful effects.
ROVNER: That's why all the defunding and repeal votes in Congress, not to mention the dozens of lawsuits challenging the law's constitutionality.
Of course if you're supporting the law, what you want is to sink those roots in so deep as to make the law, well, unrepealable. Cannon knows a little something about that too.
CANNON: You want to create constituencies that will fight to preserve it. And by sending $250 checks to seniors you may be creating constituencies, by giving tax credits and subsidies to employers you may be creating constituencies. And 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.
ROVNER: And those are just a few of the law's benefits - things like starting to fill in the Medicare prescription drug donut hole for seniors.
Ron Pollack of Families USA, who does support the law, says that as the public sees more of the law's benefits, support for it will grow. But he says it's about more than just buying off individual constituencies. It's about what the law actually does for people.
RON POLLACK: Those people who've got preexisting conditions, they don't want to be denied coverage by insurance companies. Those people who've got health conditions, they don't want to be charged an arm and a leg in discriminatory premiums. When people get sick, they don't want to lose the health coverage they've been paying for for many years.
ROVNER: Pollack also says supporters of the law are still fighting to help the public understand the 2,000-page-plus measure.
POLLACK: There are so many myths about this legislation - from death panels, government takeover, that this is adding to the deficit. None of those things are true.
ROVNER: 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.
CANNON: Governors should not be taking the funds that are available under this law and not setting up those new government bureaucracies, because that further entrenches the law.
ROVNER: 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.
Julie Rovner, NPR News, Washington.
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