The politics of ObamaCare are shifting.
A law that helped Republicans sweep into the House majority in 2010 and contributed to Democrats losing the Senate four years later might be becoming a bigger political problem for the GOP than it is a liability for Democrats.
While conservative Republicans insist they will keep working to repeal the law and that the Affordable Care Act will be an issue in next year’s presidential election, the White House and its supporters are growing more confident it will stand the test of time.
The nation’s uninsured rate made a historic drop, giving Obama something to boast about. And the second year of open enrollment for the law's insurance exchanges went off without a hitch as enrollment swelled to more than 16 million people.
Nearly 90 percent of people who have bought healthcare plans benefit from ObamaCare subsidies, and new data shows the majority like their new insurance plans. Around the country, hospitals are seeing fewer emergency room visits, and doctors are moving away from payments based on the number of procedures, rather than the care of their patient.
Health and Human Services Secretary Sylvia Mathews Burwell said the court’s decision in favor of the law shows the it is now “in the fabric” of the nation’s healthcare system.
“It is accepted,” she said, adding that some pieces of the law, such as new insurance protections and cost-cutting measures, are “just getting built in.”
Some independent observers also said the latest court ruling locks in the law.
“With each passing day, it becomes harder and harder to imagine this law being repealed,” said Larry Levitt, vice president at the Kaiser Family Foundation, which does nonpartisan health analysis. “There are just too many people covered, and it's just too big a part of the healthcare system to turn back the clock.”
Even before the Supreme Court’s decision, there were signs of division among Republicans.
Some Republican governors have accepted the law's Medicaid expansion, while others are holding out. With the court victory, Obama on Thursday said he would be working hard to convince the remaining states to expand.
Before the ruling came down, some in the GOP were arguing that the party should work to replace the subsidies in the event of a defeat for the administration. Others argued Republicans should allow the entire law to collapse under its own weight, as they had long predicted it would ultimately do.
Whether to fix or repeal the healthcare law is a debate that has raged in the GOP ever since the Supreme Court first upheld most of the Affordable Care Act in 2012.
Two days after Obama was reelected, Speaker John BoehnerJohn BoehnerClinton maps out first 100 days The Hill's 12:30 Report Boehner on Cruz: 'Lucifer is back' MORE (R-Ohio), asked about future repeal votes, saying, “I think the election changes that.”
“It's pretty clear that the president was reelected. ObamaCare is the law of the land,” he told ABC News.
A year later, Sen. Ted CruzTed CruzTrump: Cruz is 'lucky' that I walked in on his speech Kasich leaves door open to Trump endorsement Instead of being bold, Clinton errs in picking Kaine MORE (R-Texas) and other conservatives determined to repeal the law before its full implementation helped trigger a 16-day government shutdown over funding the law.
The political damage to the GOP was quickly negated by the disastrous rollout of HealthCare.gov, which contributed to the GOP’s midterm victories in 2014.
The debate over how to handle ObamaCare went into overdrive in the weeks ahead of the Supreme Court ruling.
One reason for the GOP angst was that, if the subsidies had been eliminated, constituents in states led by Republican governors would have been disproportionately affected.
Many Republicans now hope to seek repeal of the law through a budget process known as reconciliation. The procedure allows bills to be passed on a majority vote, meaning a reconciliation measure that repealed the healthcare law could go through the Senate on a majority vote with no Democratic support.
Even then, it would face a certain veto from the president.
And the GOP got bad news last week when the nonpartisan Congressional Budget Office (CBO), led by a director handpicked by Republicans, found repealing the law would add to the deficit.
The CBO score is a big problem for Republicans since reconciliation measures must reduce the deficit.
Despite the divisions in the GOP, ObamaCare is far from a political winner for Democrats.
While polls show that approval for the law is starting to tick up, a sizeable share of the public disapproves of the law.
A New York Times/CBS News poll this month found 47 percent of adults approve of the law, while 44 percent disapprove, the first time the poll had found approval higher than disapproval. A Kaiser Family Foundation poll this month found a higher favorability rating for the law for the first time in three years.
The White House is still haunted to an extent by the problems of the HealthCare.gov website and Obama’s old promises that people who liked their insurance plans could keep them.
The GOP base is dead set against the law, and that opposition continues to energize the Republican Party. Fundraising off the law can bring dollars to Republican candidates and committees, and Levitt warns the administration faces an uphill battle in trying to boost public opinion five years after the law’s passage.
It’s also possible that premiums could rise under ObamaCare, creating a backlash for Democratic candidates that seek to tout the law.
One of the Kaiser Family Foundation’s studies released last week — which included full sets of data from major cities in 11 states — showed that the increases for benchmark silver plans will be about 4.4 percent. That's an increase from the 2 percent growth last year, but far less than the doom-and-gloom predictions from the GOP.
Overall, Democrats are relatively united around the law, while Republicans are divided over what to do next.
Many in the GOP say their hopes rest on winning the White House in 2016.
“I think next steps, whatever they are, really do need to include the ballot box and the 2016 election,” Rep. Michael BurgessMichael BurgessGoonies, Pokemon and ‘transsexual shake’ speak to raucous scene at convention FDA to finalize rules on lab tests over GOP opposition Lawmakers: Smartphone health apps need to be smarter MORE (R-Texas) said.