President Obama's healthcare reform law remains as controversial as ever one year after its enactment as Democrats and reform proponents prepare to celebrate the anniversary with almost 200 events across the country next week.
The stakes couldn't be higher, as public opinion remains split on the president's signature domestic achievement and judicial threats loom. One federal court has already stricken down the law's individual mandate — a cornerstone of the law's insurance market reforms — and another has tossed out the whole law.
On the political front, House Republicans have already voted to repeal the law, while the GOP promises to do likewise in the Senate if it wins a majority in next year's elections.
With that in mind, lawmakers and advocates are looking for any edge they can exploit to shore up support for the law. A dozen advocacy groups are coordinating almost 200 events in 35 states next week, with a different theme for each day of the week:
Monday: Protecting small business's care
Tuesday: Protecting seniors' care
Wednesday: Protecting patients' rights
Thursday: Protecting women's care
Friday: Protecting young adults' care
"The prospects for repeal, and the question of whether the individual mandate will ultimately be ruled unconstitutional by the Supreme Court, remain as unclear as ever," liberal blogger Greg Sargent summarized on Friday. "So all Democrats can do is keep fighting to change public opinion on the law, and hope for the best."
It's not just about electoral politics, though.
Some advocates clearly hope to influence judges and the Supreme Court justices who are almost certain to end up ruling on the law, perhaps as early as next summer.
"There's a belief that the judge's perception at times rests upon [public opinion]," said Heritage Foundation legal scholar Robert Alt, who made it clear he's skeptical of that argument. Public displays of support "can ease the judge's concerns that the people aren't going to rise up with pitchforks."
State parties and Organizing for America, the political arm of the president's 2008 campaign, have more than 100 events planned, for example. And the health advocacy group Families USA on Monday will release state-by-state data showing how the law "in its first year has brought dramatic benefits to millions of small businesses, Medicare beneficiaries, children and young adults."
As for Democratic lawmakers, they've been instructed to keep beating the drum for healthcare reform during the recess week.
"Each one of us will go back to our district and try to make a statement," Rep. G.K. Butterfield (D-N.C.) told The Hill. "Whether it's a town hall meeting or a press release or some type of event, we've been encouraged to do that."
Here's a brief rundown of some of the twists and turns since the law's passage:
• March 23: President Obama signs reform into law. Democrats declare victory. The same day, governors and attorneys general in 19 states challenge the individual mandate in Florida federal court; Virginia AG Ken Cuccinelli files his own lawsuit in Virginia.
• June 10: The first $250 Medicare prescription drug rebate checks are in the mail, part of the law's "early deliverables" aimed at seniors. About 4 million beneficiaries are expected to get the checks because they fall in the prescription drug "doughnut hole."
• June 22: Obama marks the law's three-month anniversary with a Patient's Bill of Rights of new patient protections provided by the law. The new rules cover annual and lifetime limits on benefits, rescissions, pre-existing conditions for children and consumers' choice of doctor and access to out-of-network emergency care.
• September: New rules prohibiting health plans from denying coverage for sick children go into effect. Democrats tout the law's benefits but suffer a setback when plans stop issuing new children-only policies in as many as 29 states.
• October: The administration grants 30 temporary waivers from the law's $750,000 floor on annual benefits. To date, the administration has granted more than 1,000 waivers covering 2.6 million people — feeding predictable GOP criticism that they're either reserved for Democratic allies or proof that the law doesn't work (or both).
• Nov. 2: Democrats get trounced at the polls, losing 63 seats in the House and six in the Senate. Repealing healthcare reform is a key platform for Republicans.
• Nov. 5: HHS announces a choice of high-risk pool plans after revealing that far fewer people with pre-existing conditions are signing on to the reform law's state-based pools than expected. Only about 12,000 people enrolled in the pools during the first six months, even though millions are eligible.
• Jan. 19: House Republicans fulfill their electoral promise and repeal healthcare reform, 245-189. Only three Democrats — Reps. Dan Boren of Oklahoma, Mike McIntyre of North Carolina and Mike Ross of Arkansas — join the entire GOP Caucus in voting for repeal.
• Jan. 31: A federal judge in Florida strikes down the entire law, setting up a Supreme Court showdown, possibly as early as next summer. A judge in Virginia has also stricken down the law's individual mandate, while three judges — in Michigan, Virginia and the District of Columbia — have found the law constitutional.
• Feb. 2: A vote to repeal the vote in the Senate fails on a 47-51 party-line vote.
• Feb. 28: President Obama announces his support for bipartisan legislation allowing states to apply as early as 2014 for a waiver from certain requirements of the law, including its individual mandate. The move is part of the administration's campaign to demonstrate flexibility, but many state officials remain unconvinced.
• March 8: Maine is the first state to get a waiver from the law's medical-loss-ratio requirement, which requires individual and small-group plans to spend at least 80 percent of premiums on healthcare benefits or give consumers a rebate. Six other states — Georgia, Florida, Kentucky, Nevada, New Hampshire and North Dakota — have applications pending.
Correction: The number of high-risk pools enrollees is about 12,000, not 20,000.