After Years Of Political Talk, The Obamacare Fight Gets Real The partisan battle over the health care overhaul stretches back nearly five years. The Affordable Care Act has survived more than 50 votes in Congress and a Supreme Court challenge. But now that the exchanges are open for business, the debate is moving from plans and policy to actual results.
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After Years Of Political Talk, The Obamacare Fight Gets Real

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After Years Of Political Talk, The Obamacare Fight Gets Real

After Years Of Political Talk, The Obamacare Fight Gets Real

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It's MORNING EDITION, from NPR News. I'm Steve Inskeep.


And I'm David Greene, good morning. Today is the day the Affordable Care Act becomes operational. Americans can begin signing up for health insurance at online marketplaces known as exchanges. Now, since the president signed Obamacare, it has survived more than 50 votes in Congress, a Supreme Court challenge, a presidential election and, as of this morning, a government shutdown.

Much of the spending for the law is mandatory and will not be cut off. But now, Obamacare must survive something else - its own implementation. Here's NPR's Mara Liasson.

MARA LIASSON, BYLINE: The political battle over Obamacare is nearly five years old. But today, says GOP pollster Bill McInturff, a new chapter begins.

BILL MCINTURFF: What happens today is, we're going to move from this policy debate about Obamacare to a reality outcome debate; what impact does it have on millions and millions of Americans, and do they judge it to be good or bad? And I believe attitudes will shift, based on that reality of the outcome of Obamacare.

LIASSON: The president is confident that attitudes will shift in his direction. Like the "Green Eggs and Ham" story invoked by Sen. Ted Cruz, Obamacare's chief antagonist in Congress, Mr. Obama is certain that when Americans try it, they will like it.


PRESIDENT BARACK OBAMA: That's what's going to happen with the Affordable Care Act. And once it's working really well, I guarantee you they will not call it Obamacare.


LIASSON: Obamacare, as it will be called for the foreseeable future, has already exacted a stiff political price from the president.


PROTESTERS: Obamacare equals economic slavery. Obamacare equals...

LIASSON: Opposition to Obamacare fueled the rise of the Tea Party, which led to the Democrats' historic loss of their House majority in 2010. But Republicans paid a political price, too. Their efforts to repeal the law in 2012 failed, and Democrats held on to the White House and the Senate. Through it all, public opinion has been consistent - consistently negative about the law even if voters don't want it defunded. Health care historian Jonathan Oberlander says that's why he's not sure even a flawless rollout will change perceptions.

JONATHAN OBERLANDER: This is not a program like Medicare or Social Security. It is a program that really is a series of policies and regulations and subsidies. And that makes it difficult to explain to the uninsured what the benefits are. And I don't think it's going to be easy for Obamacare - regardless of how well, or not, it does the next year - to overcome that chasm.

LIASSON: And both parties think the law helps them politically. Democratic pollster Geoff Garin says Republicans have overreached by staking everything on stopping the law.

GEOFF GARIN: The Republicans have made the debate about Obamacare a debate about them and their tactics and - and their wanting to repeal it totally rather than a debate about Democrats or whether Obamacare is a good or a bad thing.

LIASSON: But Republican economist Douglas Holtz-Eakin says there are good reasons the GOP has planted its flag on Obamacare.

DOUGLAS HOLTZ-EAKIN: I've had many people come up to me and say: Why do Republicans do this? And I say, well, the polling tells them to. It continues to be the single thing that moves independents. So you get the famous swing voters. Nothing generates more political animation than Obamacare. So you if you look at intensity and turnout, it still works.

LIASSON: Republicans see independent voters as the key to their two goals in 2014: regaining control of the Senate, and expanding their majority in the House. And there's also another dynamic motivating Republicans. Many feel this is their last chance to stop the law. Here's Sen. Cruz on Fox News.


SEN. TED CRUZ: If we don't do it now, in all likelihood, Obamacare will never, ever be repealed. Why is that? Their plan is to get the American people addicted to the sugar - addicted to the subsidies. And once that happens, in all likelihood...

UNIDENTIFIED MAN: It's over. Never gets repealed.

LIASSON: Surrender is unthinkable for either side in this fight. That's because the health care debate reflects the deepest divide in American politics: the core beliefs of the two parties about the role of government. That debate is, for now, at a standoff. Bill McInturff...

MCINTURFF: We ask very simple questions: Do you think the government should do more, or less? And that's a 48-48 proposition right now, in the country. And it's been that way for about a decade. And guess what? If you've got a country that's poised at 48-48 about whether government should do more or less, and we have a health care issue that is absolutely wrapped around that question, it's not surprising that it's led to this sort of paralysis that has made this a very contentious issue for cycle after cycle.

LIASSON: Obamacare is not only the law of the land. It's also, as of today, a practical reality for millions of Americans. But as a political issue, it's far from settled - and won't be anytime soon.

Mara Liasson, NPR News, Washington.

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