The Affordable Care Act, the health care reform law scorned as "Obamacare" by Republicans, may be President Barack Obama's biggest achievement or the biggest obstacle to his re-election.
In a new public relations offensive surrounding the second anniversary of its passage, Obama's campaign is promoting it as a political plus.
But Republicans, and some polls, suggest Obama may have difficulty turning the health care reform law, which generated red-hot political controversy through 2010, into an electoral advantage.
Obama's strategy is to focus attention on parts of the law already in effect, many of which are popular and consumer-oriented:
Not mentioned are features yet to take effect that have generated most of the controversy and may generate increased taxes and insurance premiums.
They include the "individual mandate" requiring all citizens to buy a health insurance policy, which some say is unconstitutional; measures to lower the long-term growth in the cost of Medicare, which critics say will hurt coverage; expansion of Medicaid eligibility, which states say will cost them billions; and government-sponsored exchanges offering private policies to those whose employers don't offer group insurance.
The campaign is helped by the plan's implementation dates, said Jay Wolfson, health policy expert at the University of South Florida College of Public Health and an advocate of health care reform.
"We got dessert first — the easy, palatable things that people like."
Much of the cost, he said, will come later.
"Costs are going to have to be shifted somewhere, either taxes or health insurance premiums, to cover the costs of those who can't afford the full costs of their own coverage."
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The Obama campaign effort won't work, said Ryan Williams, a spokesman for the Mitt Romney campaign.
"President Obama understands that it's a major liability for his re-election," he said. "In 2010, Democrats were trounced — Obamacare resulted in massive losses.
"The president can spend as much as he likes on mailers and public relations, but Americans know it was the wrong approach," Williams said.
The Obama offensive began last week. The effort includes mailers to voters in several states, including Florida, targeting female voters and emphasizing the benefits to women and families, and state-by-state statistics detailing how many people have benefitted from the new features. Nurses for Obama organizations launched with news conferences in Florida and several other states.
"American families are seeing how reform is saving lives and saving money," said a campaign news release, citing "seniors whose Medicare is now stronger … women who today can get life-saving mammograms at no extra cost … children who will no longer lose their coverage because they were born with pre-existing conditions."
The campaign said 160,000 Florida young adults are covered by their parents' health care plans; 960,000 children with pre-existing health conditions can no longer be denied coverage; and all health policy holders have benefited from the new coverage rules.
The campaign emphasized polling figures from the Kaiser Family Foundation, a health care think tank, which show a generally favorable to neutral public view of the law.
In December, the foundation found big majorities, 60 percent to 80 percent, favoring such parts of the law as preventing coverage denials for pre-existing conditions and requiring that a set percentage of insurance companies' premium revenue be spent to pay for care rather than administrative costs or profits.
The exchanges, and a plan to offer small businesses tax credits for providing group coverage, were also popular.
In a January poll, 61 percent said their families will be better off or see no difference under the law, and 56 percent said the country will. Half said the law should be expanded or kept as is, and 40 percent advocated repeal.
But that poll and others also included less-favorable figures.
The January poll showed 44 percent with very or somewhat unfavorable views of the legislation, to 37 percent favorable. Since the law's passage, when it was initially popular, favorable views have declined steadily and unfavorable opinions increased in the face of a steady drumbeat of criticism from Republicans.
Meanwhile, a USA Today poll in 12 political battleground states including Florida last week said voters opposed the law by 53 percent to 38 percent.
In a conference call announcing Florida Nurses for Obama, campaign manager Stephanie Cutter said overall opinions of the law "are largely rooted in partisan politics. What the USA Today poll didn't show was how hugely popular particular provisions of the law are."
On that call, Jacksonville nurse Margaret Johnson Refour, a 23-year veteran, said she is accustomed to seeing young diabetic patients coming to the emergency room because they lack maintenance care, hypertension patients coming in because they can't afford medication, and "people showing up in the ER for something a simple as a sore throat."
"My fellow nurses and I know better than most why we desperately needed this health care reform," she said.
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Obama's strategy, said University of Florida political scientist Dan Smith, is "the Vince Lombardi strategy — you go after the opponent's strength, and if you can beat them on that issue, you can take them down."
Republicans, he said, have won the debate on "the larger framing, government intervention," but that could leave Obama an opening.
"Americans don't like big government, but when you ask them about specifics, whether they want the FDA protecting food and drugs, or the EPA cleaning up water and air, or the Department of Agriculture inspecting food processors, the numbers flip."
Romney has promised repeal of the Affordable Care Act, saying he will issue an executive order "on Day One" of his presidency to waive the individual mandate requirement and then will work with Congress to seek repeal.
Romney spokesman Williams said Romney favors some of the law's features, including ending "discrimination against those with pre-existing conditions," but his published health care proposal doesn't include specifics on what he would do to maintain those features.
Cutter responded that repeal "would have real negative consequences. … You'd have to go back to the days of paying out of pocket for mammograms and colonoscopies."
"He wants to put control of your health care not in your hands, but in the hands of your employer," she said.
Wolfson, of the USF College of Public Health, said he doubts Romney can keep his word, even on the executive order. "There's no provision in the law to allow that," he said.
Americans don't take a realistic approach to health care, and the result is a system that's hugely expensive but also doesn't work, he said.
"When it comes to health care, people want access, quality and choices, but they're not willing to pay for it," Wolfson said. "Or if they're willing to pay for themselves, not for other people."