Consumer advocates, doctors groups and many health industry leaders remain committed to helping the law succeed. Most believe in its goals of expanding health coverage and restructuring the medical system to improve quality and control costs. Few see any viable alternatives.
But even as President Obama launched another attempt last week to rally Americans behind the law, many of his allies believe his administration is no better prepared for the inevitable challenges of moving millions of people into new health plans than it was for the rollout of the federal HealthCare.gov website.
"The refrain we most often hear is: 'Where is the administration?'" said M. Ryan Barker, vice president of the Missouri Foundation for Health, which has been working for nearly four years to help smooth implementation of the law in the state. "It is very frustrating."
Like many of the law's backers, foundation leaders have decided they and their local partners must take responsibility for educating consumers about their new coverage and responding to questions and complaints because the Obama administration has shown little ability to do it.
Many physician groups, hospitals and insurers have come to the same conclusion.
"I have never seen medical providers more dismissive of a White House," said one longtime healthcare lobbyist, who asked not to be identified in speaking so frankly about the president's leadership.
A health industry chief executive who supports the law bemoaned the Obama administration's lack of preparation for even foreseeable complications, such as the recent cancellations of millions of health insurance plans that don't meet the law's new standards. "There just doesn't seem to be much strategic thinking," he said.
White House officials acknowledge the disastrous debut of HealthCare.gov has made it difficult to highlight the law's benefits and respond to criticisms. But they say they are now prepared for a sustained campaign through next year, building on their work with advocates nationwide to enroll people in health coverage.
David Simas, senior advisor to the president on healthcare, said this new sales effort will not only showcase people who are benefiting from the law, but also compare the new protections with the shortcomings of the prior system, which left millions of Americans without health coverage.
Starting in 2014, health plans will be prohibited from turning away sick customers and will have to offer a basic set of benefits, including coverage of
"Now, we can begin to tell a story," Simas said. "We just have to execute. Period.... That's what we're going to do. We're going to execute on that day after day after day after day."
The White House last week publicized some of its efforts to protect the law from more political trouble. The administration is distributing talking points to Democrats and other allies, as well as hosting daily calls with advocates and key lawmakers to coordinate messages and responses to critics, an official said. And a former White House liaison to Capitol Hill who worked to pass the law, Phil Schiliro, will return temporarily to coordinate strategy with congressional Democrats.
Several administration allies in Washington said they are hopeful this campaign may be more successful.
"I don't want to be Pollyannaish about this, having gone through great difficulties in the past, but I feel better than I've felt in months," said Neera Tanden, president of the Center for American Progress and a former administration official.
Many advocates and industry leaders who support the Affordable Care Act also believe the law's benefits will become clearer to Americans as more experience the security of health coverage, especially if they are ill.
"A lot of people are going to be pleasantly surprised by how good the coverage is," said Daniel Zingale, senior vice president of the nonprofit California Endowment, which has committed more than $200 million to help implement the law in the state.
Indeed, despite the problems with the launch of HealthCare.gov, the online insurance marketplace for consumers in 36 states, there has been strong interest, with hundreds of thousands of people a day viewing the federal site and similar state sites.
But experts acknowledge public appreciation will take time. "We are in the beginning of a very long-term transition in the nation's healthcare system," said Dan Mendelson, chief executive of Avalere Health, a Washington-based consulting firm.
In the interim, many supporters worry that more bumps in the law's implementation could further undermine public confidence, especially without a sustained, strategic plan from the Obama administration.
"This is going to be a battle every step of the way," said one Democratic official involved in the new messaging push who asked not to be identified in order to candidly discuss the work of White House officials. "It's unclear whether or not they realize that this is not a three-week PR campaign.... There's a long list of issues, serious issues that are going to come up as part of implementation, where Republicans are going to try to score political points or derail the law. And we have to be ready."
Many advocates are particularly worried that consumers who are confused or angered about their new insurance could turn their frustrations on the law.
Some patients are likely to find that their doctors cannot verify their coverage because their applications weren't processed accurately by the troubled enrollment system.
In October and November, before repairs were made to the website, as many as a quarter of insurance sign-ups had errors. The administration said last week that the rate is about 1 in 10. Administration officials say they are contacting consumers and telling them to confirm their enrollment with their insurer.
Advocates worry that other headaches await patients trying to use health insurance for the first time.
Some will discover the doctor they want to see is not in their network, an issue Republicans have already started to cite in their efforts to discredit Obamacare.
Others will find that a preferred prescription drug is not covered by their health plan.
For others, the high deductibles in many plans may come as a shock. Some who have never had insurance may not realize that their monthly premiums will not cover many of their medical expenses.
"A lot of patients are not going to be real happy," said Tom Banning, chief executive of the Texas Academy of Family Physicians.
Molly Firth, public policy director at Community Health Network of Washington, which provides health coverage to poor Washington state residents, said she and others are concerned that low-income patients may select health plans with low monthly premiums, saddling themselves with high out-of-pocket costs.
More challenges could emerge as insurers decide which plans to offer in 2015 and how much they will cost. Some rates, which will start becoming public over the summer, may increase substantially.
The White House says it is anticipating these and other concerns, but declined to offer many details on how it would address them. Officials said HealthCare.gov had been updated to improve consumer education on such issues as deductibles and prescriptions. The so-called doc shock was the subject of talking points recently sent to lawmakers and allied groups. The White House also plans to assemble state data on the impact of the law to distribute to local officials.
Outside Washington, however, few are waiting for the White House.
"For us, it's turned from a frustration to a motivation," said Baker, the Missouri Foundation for Health vice president. "We've decided, 'Let's just do it.'"