President Obama reentered the political battle over healthcare Tuesday, delivering an extended defense of the Affordable Care Act as the Supreme Court prepares to issue its ruling on a case that could strip away health insurance from millions of Americans.
"It seems so cynical to want to take coverage away from millions of people," Obama said, taking a swipe at the Republicans who have backed the latest legal challenge to the law, "to take care away from people who need it the most, to punish millions with higher costs of care and unravel what's now been woven into the fabric of America."
Obama's address, to a gathering of hospital leaders from the Catholic Health Assn., comes at a pivotal moment as his signature domestic achievement faces its gravest threat since being narrowly upheld by the Supreme Court three years ago.
The current legal challenge brought by conservative activists argues that a strict reading of the statute makes insurance subsidies in the law available only in states that established their own insurance marketplaces through the law.
That would strip subsidies from residents of more than 30 states that rely on the federal HealthCare.gov marketplace. More than 6 million people could lose coverage almost immediately, with millions more expected to follow as insurance markets collapse in many states.
The ruling, expected this month, is likely to reignite a fierce national political battle over healthcare that had been petering out in many places as more Americans got coverage and GOP lawmakers looked to move on to other issues.
The president enters the renewed healthcare debate in a stronger position than at any time since he signed the law in 2010. Although problems with the law persist and some consumers who benefited from the old system that allowed insurers to deny coverage to sick people have seen premiums rise, millions more have gained coverage.
Congressional Republicans, meanwhile, now face the prospect of being blamed for massive disruptions caused by a legal case they championed.
Many are already stepping up their criticism of the law.
Within hours of Obama's speech Tuesday, Sen. John Thune (R-S.D.), who chairs the Senate Republican Conference, took to the Senate floor to argue the health law was "unraveling."
"The discussion about Obamacare's success or failure is no longer theoretical," Thune said, citing reports of rising premiums around the country and the ongoing struggles of some states to operate their new insurance marketplaces.
"The evidence is in, and it shows that the president's healthcare law is broken. It's time to repeal Obamacare and replace it with real healthcare reforms that will actually drive down costs," Thune said.
Speaking on a radio program in Kentucky, Senate Majority Leader Mitch McConnell (R-Ky.) repeated his claim that the law is the "single worst piece of legislation passed in our country in the last half-century."
Republicans largely won the political battle over the Affordable Care Act, capitalizing on its controversial passage and flawed rollout to win sweeping victories in the 2010 and 2014 congressional midterm elections.
Democrats, meanwhile, bemoaned their president's inability to use his rhetorical skills to rally public opinion behind the healthcare law.
Today, however, the law is no longer an abstract promise.
With millions gaining coverage, polls show a small but measurable uptick in public support. Those holding a favorable view of the law slightly outnumbered those viewing the law unfavorably in an April national tracking poll by the Kaiser Family Foundation. That is the first time that happened since November 2012, just after Obama's reelection.
The law is now widely credited by independent analyses with driving the largest decline in the nation's uninsured rate in at least half a century. Rand Corp., a Santa Monica nonprofit research firm, reported last month that the number of Americans without coverage declined by nearly 17 million since the law's coverage expansion began last year.
And the rising insurance premiums cited by Thune and others are being fueled in part by uncertainty over the legal challenge backed by the GOP.
Obama ticked off indicators of progress Tuesday, noting the insurance expansion, the new protections for Americans with preexisting medical conditions, the slowdown in healthcare spending and the surveys that show large majorities of people satisfied with the new coverage they have through the law.
The president also could draw on a growing number of people who have benefited from the law, several of whose stories he cited Tuesday.
"This isn't about myths or rumors that folks try to sustain," Obama said. "There is a reality that people on the ground day to day are experiencing. Their lives are better."
Republicans, meanwhile, still haven't advanced any alternative to the Affordable Care Act.
McConnell refused Monday to discuss what the GOP would do if the Supreme Court upholds the challenge.
"We'll let you know depending upon the outcome of the decision," he said when pressed by the host of the "Joe Elliott Show" on WGTK-AM (970) in Louisville, noting only: "We'll have a plan that we think makes sense for the American people."