March 27--President Barack Obama's signature domestic achievement became law two years ago.
The congressional debates, the tea party protests, the criticism and the praise over national health-care reform gradually faded into the background after dominating the national conversation in the first two years of his presidency.
But the conversation about the Patient Protection and Affordable Care Act -- known derisively by critics as "Obamacare" -- is back, in a big way.
The anniversary itself, the U.S. Supreme Court's hearing of the law's constitutionality, and a rancorous presidential election season are all forces that have combined to put the law back on the front burner.
Even after the court finishes hearing arguments Wednesday, the issue will remain at the forefront for months to come.
The Supreme Court is expected to rule early this summer and the campaigns for president and Congress will keep the issue on a high boil.
"It's going to be one of the major news stories of the summer," said Robert Speel, associate political-science professor at Penn State Behrend.
Depending on which candidate emerges as the GOP nominee, the issue could be woven into the presidential campaign narrative until the Nov. 6 election, Speel said.
Mitt Romney signed a health-care reform bill as governor of Massachusetts, which was the model for the national law. But Romney, Rick Santorum, Newt Gingrich and Ron Paul all have said they would repeal the Affordable Care Act.
Speel said that if front-runner Romney becomes the nominee, he'd have a tougher time criticizing Obama on health-care reform.
But Speel said the other GOP candidates likely would make it a central part of the election campaign.
Santorum is taking on both Obama and Romney at the same time, calling for the repeal of what he calls "ObamaRomneycare."
Santorum has said that "Obamacare" would be a "death knell for freedom."
Opponents also have charged that the worst fears of the legislation have already come into play in the form of higher costs and regulations, which the law's supporters refute.
The case is now before the Supreme Court, which likely will rule on one of the most divisive parts of the law -- the individual coverage mandate.
Arguments are scheduled today on that issue.
The court will consider whether it's constitutional for the federal government to require individuals to get health insurance, either through an employer, a government program or by direct purchase -- and face a financial penalty for not doing so.
"It's an example of what many conservatives would label as big government run amok," Speel said.
Critics have seized upon the timing of the anniversary and the high court's hearing of the case to renew a call to throw out all or part of the law.
And the Obama administration has highlighted some parts of the law already in place, such as allowing adult children to stay on their parents' health-care coverage until age 26 if they don't have a job or work without insurance coverage.
Last week, the Obama campaign in Pennsylvania held a conference call with reporters -- including the Erie Times-News -- in which a working Philadelphia mother of four children said she embraces that part of the law.
Sara E. Calderon said that she and her husband don't have to worry if their oldest daughter, a 22-year-old college graduate, gets sick because she is covered through their employer-based insurance plan. Their daughter works for a nonprofit that isn't providing her with health insurance.
The Calderons have another daughter in college, and two more in high school, and Sara Calderon said she is the caretaker for her 73-year-old mother.
"I know that there are a lot of people out there like me, working full time, raising kids, caring for a parent, and every little bit helps," she said.
The Obama administration said that nationwide, 2.5 million more young adults have health insurance on their parents' plans, including about 1,400 in Erie County.
But Americans are largely divided over the law.
A Pew Research Center survey released last week showed that 47 percent approved and 45 percent disapproved of the law, with the rest saying they don't know.
The survey reflects the ideological divide between the two major parties.
The survey showed that 84 percent of Republicans reject the law, while 76 percent of Democrats support it. Independents, a key voting bloc that could decide the election, are divided -- with 44 percent approving, 47 percent disapproving and the rest unsure.
But a New York Times/CBS poll released Monday shows that 47 percent of Americans disapprove of the law, while just 36 percent approve.
Some pieces in place
While many parts of the law would be phased in through 2020, several other pieces of the law are already in place.
- Insurance companies can no longer deny coverage to children because of a pre-existing condition. That will apply to everyone starting in 2014.
- Insurance companies can't set a lifetime limit on the dollar amount of coverage that patients receive.
- Insurance companies must spend 80 percent of premiums on care.
- The coverage gap, or so-called doughnut hole, to pay for prescription drugs has started to close for seniors and people with disabilities on Medicare. The hole is scheduled to close entirely in 2020.
- Health plans cover preventive care without charging co-pays. That includes Medicare.
Most of the major provisions would roll out in 2014.
- Coverage to more than 30 million uninsured.
- Expansion of Medicaid to cover more low-income residents.
- Creation of exchanges, or state-based health insurance markets, for small businesses and those buying private coverage individually.
- The individual mandate requirement, in which the Internal Revenue Service would issue a fine for noncompliance.
- A requirement that companies with 50 or more employees provide coverage to their full-time workers.
Other changes are coming, too, for hospitals in the way they will be paid by Medicaid and Medicare.
Rather than a fee-per-service basis, the model under reform calls for them to be paid in part based on a series of quality measures and patient outcomes.
Both Saint Vincent Health Center and UPMC Hamot are among the hospitals already moving toward treating patients under that quality measurement.
"That's why we think the Supreme Court decision is important, but it doesn't affect how we deliver care today," said Scott Whalen, chief executive of Saint Vincent Health System.
And John Malone, chief executive of UPMC Hamot, said that no matter how the Supreme Court rules, health-care reform is needed. "I view health-care reform and the legislation and all that surrounds that as a positive impetus to really change the way the system operates, and hopefully in a positive and helpful way," he said.
In the meantime, health-care providers, insurance companies, businesses, politicians, the insured, and the uninsured will eagerly await the high court's ruling.
"If you've got a crystal ball that will tell me how the Supreme Court will rule, I'd be happy to hear the results," said Vikram Mangalmurti, vice president of the Office of Health Care Reform for Highmark Blue Cross Blue Shield, which already offers a pay-for-performance program for participating hospitals and physicians.
The Associated Press contributed to this report.
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