En español | The Obama administration celebrates the new health care law's first birthday on March 23 — amid a swirl of court challenges and Republican attempts to repeal it that has left one in five Americans believing the law already has been repealed.
But while tweaking some details of the Affordable Care Act, government officials are rolling out its early provisions and laying the groundwork for the main ones scheduled to start in 2014. "We have a law and we will continue to implement it," Health Secretary Kathleen Sebelius maintains.
Meanwhile, the law's supporters point to new benefits that have already gone into effect, including:
- banning insurance companies from denying coverage to children with health problems, dropping coverage for policyholders who get very sick or putting lifetime dollar limits on benefits;
- allowing young adults to stay on their parents' policies until age 26;
- offering access to health insurance for people whose medical conditions make them otherwise uninsurable;
- giving small businesses tax credits to help them insure employees;
- providing many free tests and screenings in Medicare;
- issuing $250 checks to everybody who fell into the Medicare Part D "doughnut hole" in 2010;
- halving the drug costs of people who fall into the doughnut hole this year — the first step in closing the coverage gap completely;
- setting annual limits on out-of-pocket spending for people enrolled in Medicare Advantage health plans.
It's unclear whether these popular measures could survive if the law is finally overturned. Among the legal challenges, so far three federal judges have ruled that its cornerstone — the unpopular requirement for everyone to have insurance or pay a fine — is constitutional while two others have held that it is not. The issue will ultimately be decided by the Supreme Court.
In Congress, the new GOP-controlled House's vote in January to repeal the law outright was seen as a symbolic gesture that had no chance of being enacted — at least as long as Democrats continue to control the Senate and the White House. But it gratified the Republicans' conservative base.
And it had an impact on public opinion. Almost half of Americans think the law is no longer in effect (22 percent) or don't know if it is or not (26 percent), according to a February poll by the Kaiser Family Foundation, a nonpartisan research group. This disconnect between fact and belief does not surprise public opinion experts.
After President Bill Clinton was impeached by the House and acquitted by the Senate 12 years ago, "it was the same thing — 30 percent of people believed he'd be removed from office," says Robert Blendon, professor of health policy and political analysis at Harvard's School of Public Health. "They see the headlines but don't understand the [legislative] process."