Obamacare turns 4: Who’s cheering, who’s heckling?

The controversial health care mandate is top of the pops in politics, but the real measure of Obamacare will be in the looming roll-out of its most controversial caveats.

Perhaps the most telling statistic about the Affordable Care Act as the controversial law turns four years old on Sunday is this: 70 percent of Americans still don’t know they could get their healthcare subsidized under the law.

But for those who do understand what the law is, what it does, and how it’s changing life in America, Obamacare’s 4th anniversary is a major turning point for the biggest federal entitlement expansion since the 1960s.

To illustrate the stakes, nearly 40 “Moral Monday” protesters were arrested in Atlanta this week as they disrupted capitol proceedings to complain about Republican lawmakers opting the state out of the law’s Medicaid expansion.

President Obama meanwhile lauded the law’s impact on healthcare for women while Republican party chairman Reince Priebus called it a “poisonous issue” for the ruling party in Washington, which has to face Obamacare’s liabilities in its defense of a Senate majority in November.

While Democrats pushed the law’s myriad benefits ahead of the March 31 deadline to sign up – 5 million Americans have signed up, short of a 7 million goal – others, like top Internet aggregator Matt Drudge, announced they had paid the first Obamacare tax – which he dubbed “Liberty Tax” – for opting out of the law.

(The $95-per-adult penalty doesn’t take effect until next year, but small business owners like Drudge who send quarterly installments to the Treasury are technically on the hook now. That penalty fee ramps up considerably in following years.)

Given the Democrats’ truth-twisting in campaign tidbits like “If you like your health insurance, you can keep your health insurance” – in fact, lots of people were dropped from their health plans – the law will likely only become more irresistible to Republicans as unintended consequences pile up.

“Millions of Americans have personally discovered that they can’t keep their coverage, can’t afford their premiums, can’t see their doctor, and can’t work as many hours,” wrote Sen. John Barrasso (R) of Wyoming on Fox News.

Passed along partisan lines in 2010, the Patient Protection and Affordable Care Act makes it illegal for insurance companies to turn people away for preexisting conditions, allows parents to keep their kids on policies until age 26, and mandates that all American adults buy a healthcare policy or face an annual tax penalty. OK’d by the Supreme Court, the law, which primarily functions through government “healthcare exchanges,” also subsidizes health care policies for low-income Americans.

After a disastrous roll-out in October, Obamacare has become the crux of the 2014 midterm elections. Unpopular among 53 percent of Americans, the law will be hard to defend in competitive districts, and could lead to a Republican takeover of the Senate.

For that reason, "it's safe to say that Democrats are going to want to ignore this anniversary," Mr. Priebus said on Friday. "The Senate is slipping away ... it seems like every day the math is expanding ... because of Obamacare, we know that Democrats are in disarray.”

Indeed, a big problem for Democrats is that the math may not ultimately add up. So far, those who will primarily pay for the law’s subsidies – young, healthy people – have not yet signed up at the rates Washington was hoping for, suggesting that a large percentage of Obamacare enrollees are older Americans with health problems.

“Although many households qualify for federal subsidies, many others find that the premiums in popular ‘silver’ plans aren’t cheap compared with the modest penalties for skipping coverage,” the Monitor’s Mark Trumbull wrote this week.

Nevertheless, former House Speaker Nancy Pelosi, an  architect of the law, urged nervous Democrats to strongly defend the law. “I believe that it’s a winner,” she said.

Four years after its passage in Congress, Obamacare looms over America as a paradox: Despite making healthcare less of a worry and financial drain for millions of Americans, it also represents for many others a creeping, even sinister, intrusion of the federal government into the lives of Americans.

“Whether the improving numbers [in Obamacare sign-ups] can be used to reshape the political climate as it relates to the health care law depends on whether Democrats on the ballot this year in competitive races have the courage to more forcefully rebut the Republican argument that the health care law is a disaster,” writes John King, on CNN.

Meanwhile, the long-term problem for Republicans is that, despite its flaws and complexities, Obamacare provides real benefits that may improve its popularity as its benefits become more ubiquitous.

In New Hampshire this week, for instance, Herb Richardson, a Republican lawmaker, called Obamacare a “monstrosity,” but later acknowledged the law had been a “financial lifesaver” for his family, CBS News reported.