A year later, healthcare reform still in contention

Wednesday marked the first anniversary of the healthcare law that advocates said would change so much. In one sense, they were right: The battle over President Obama’s signal domestic policy goal played a major role in transforming the political landscape.

The emotional debate over the bill arguably gave rise to the “tea party” movement and littered the countryside with congressional Democrats who supported the bill and then went down to defeat.

Republicans now control the House and are not far from seizing the Senate. Potential candidates for the 2012 GOP presidential nomination need only say one word, “Obamacare,” to get a rise from a crowd. And the president himself has struggled at times to ensure that his first term isn’t defined by the legislation.

Public attitudes toward the law, however, have not shifted much at all. The Affordable Care Act remains almost equally celebrated and loathed — as it was 12 months ago — despite the best efforts of Democrats to praise it and Republicans to bury it.

Even worse for both sides, a majority of Americans remain confused about what the law actually accomplishes. A sizable number don’t even realize that it has been passed and signed into law.

This week, the trench warfare heated up again.

Democrats pointed to tangible advantages the legislation has already delivered, including lifting caps on lifetime benefits, prohibiting discrimination based on preexisting medical conditions and helping seniors pay for prescription drugs. Even more benefits lie ahead, they said, as the law’s provisions go fully into effect in coming years.

Republicans continued pinning the law to the sluggish economic recovery, warning that it would balloon the deficit, and charging that it has hurt small business and lowered the quality of healthcare nationwide.

In the meantime, the law’s most controversial aspect, its requirement that all Americans have health insurance, is under assault in the courts.

Though public opinion has stayed relatively static, there’s no doubt that the GOP still senses a political opportunity. Republicans voted to repeal the law in the House and mustered a fair share of votes to do so in the Senate — and the GOP says it is committed to using the appropriations process to gut the law.

On the putative Republican presidential campaign trail, targeting the healthcare law remains a favorite sport. Candidates such as Tim Pawlenty are seeking to use the law’s persistent unpopularity to boost their profiles.

“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 in a statement Wednesday.

And Mitt Romney’s presidential prospects remain fogged in part because of his support of a similar state law while he was governor of Massachusetts.

But according to polls, advocating a full-blown repeal also carries political risk. A new survey from the Kaiser Family Foundation found that fewer than 40% of Americans favored repeal, regardless of whether Republicans replaced it with an alternative.

That suggests that while agitating against the law plays well to the GOP base, it risks alienating centrist voters who may be taking more of a wait-and-see approach.

Some in the Republican Party have recognized that certain provisions, such as ensuring that children with preexisting medical conditions can find health insurance, play well with the electorate, and have suggested that a GOP plan would accomplish the same at a lower cost through the use of purchasing pools and other market-based reforms.

Republican leaders are still working up a replacement in the House. “We don’t accept the status quo,” Rep. Tom Price (R-Ga.) said Wednesday. “There are a lot of things that need to be improved upon.”

The Republican political action group Crossroads GPS announced Wednesday that it was suing the Department of Health and Human Services for information on the administration’s waiver process.

And Democrats, rather than champion healthcare — their signal domestic legislative achievement last year — tried to change the subject.

“Republicans are continuing to refight the political battles of the past while the American public is ready to move on,” said Rep. Debbie Wasserman Schultz (D-Fla.). She said repeal would be “catastrophic.”

james.oliphant@latimes.com