As the Patient Protection and Affordable Care Act (ACA) celebrates its first birthday, the future of the law is still unclear, but its effects have been enormous. The debate over the law likely created the “tea party” movement. Last November, Republicans took control of the House of Representatives and strengthened their numbers in the Senate. Potential contenders for the 2012 Republican presidential nomination need only say one word, “Obamacare,” to get a negative reaction from a crowd. President Obama at times himself has struggled to ensure that his first term isn’t defined solely by this legislation.
Public opinion over the ACA remains divided, despite the efforts of Democrats to showcase how it will provide healthcare insurance to millions of uninsured Americans. Additionally, most Americans remain confused about what the healthcare overhaul actually accomplishes. Republicans considering a 2012 presidential race for the most part stand united in their opposition to the legislation. Former Minnesota Governor Tim Pawlenty is using his opposition to the law to gain a national following. “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. Former Massachusetts Governor Mitt Romney is in a different position because he supported a similar law during his tenure.
Representative Steve King (R-IA), the Iowa Congressman who is in the vanguard to repeal the ACA, says that “America will never become the nation it can be if were saddled with Obamacare“, “I have a deep conviction that this is unconstitutional, that this is unsustainable, and I have a duty. And that doesn’t mean I sit back and wait for the Supreme Court to save America from itself. It’s my job to step up and lead.”
Taking a difference stance, Carmela Coyle, president and chief executive of the Maryland Hospital Association, said her group strongly supports the reform law and will work to assure that the effort translates into better and cost-effective care. “We support healthcare reform because hospitals see every day what happens when patients don’t have the healthcare coverage they need and can’t get their care at the right time and in the right setting. Expanding coverage was necessary, and it was right. We must ensure that the health coverage now guaranteed to many Marylanders is meaningful coverage.”
What’s the future of the Affordable Care Act? House Republicans, who say the law gives the federal government too much control and doesn’t cut costs, passed a repeal bill after they became the majority in January. Full repeal is unlikely unless Republicans successfully take control of the Senate and the presidency in the 2012 presidential elections. The current Democratic-led Senate will not vote to repeal and President Obama would certainly veto a repeal bill. Democrats argue the law’s reforms will slow the growth of healthcare costs while improving care and reducing the ranks of the uninsured. Republican efforts to withhold funds to block the law’s implementation will be DOA in the Senate. That leaves Republicans the option of picking apart the law regulation by regulation, a strategy that could prove more successful.
In the meantime, implementation is underway. “As we look forward with implementation of the health reform law, the states really become the focus now,” said Jennifer Tolbert, a principal policy analyst at the Kaiser Family Foundation. “When thinking about the coverage expansions in particular because it is going to be up to the states to implement the expansion of the Medicaid program for lower-income individuals and to create the new health-insurance exchanges that will provide access to private insurance for moderate and middle income individuals.”
The Republican House of Representatives’ 
As healthcare reform is ushered in over the next few years, 
The real cost of failure to pass healthcare reform legislation could mean that 275,000 Americans
