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Obamacare Five Years Later: Thriving Or On Political Life Support?

President Obama speaks at the White House Wednesday about the fifth anniversary of his signing of the healthcare law.

The health care law, the Affordable Care Act, Obamacare. Whatever you call it, five years after President Obama signed the law, it remains polarizing.

Despite fierce political opposition and a rocky rollout, the law has sliced the number of uninsured by a third — 16 million people have signed up of the 48 million uninsured before the law went into effect. But Americans remain deeply split on Obamacare, and its future is unclear. Its fate could be decided in coming months by the Supreme Court — or the 2016 presidential election.

The president took a victory lap Wednesday morning, touting sign ups and affordability — and blasting Republican opposition.

"Just five years in, the Affordable Care Act has already helped improve the quality of health care across the board," Obama said at a health care event at the White House. He added, "It's making health care coverage more affordable and effective for all of us. It's working better than many of us, including me, anticipated."

Obama took sharp aim at the law's opponents.

"We have been promised a lot of things these past five years that didn't turn out to be the case — death panels, doom, a serious alternative from Republicans in Congress," Obama said, pausing for effect, as he delivered the line, drawing chuckles from the friendly audience.

The law will be getting a few more signees soon with Sen. Ted Cruz — who led a Green Eggs and Ham-fueled 21-hour speech against the law — admitting Tuesday he would be enrolling through a federal exchange. Cruz, who announced a run for president Monday, had been getting insurance through his wife, who worked for Goldman Sachs, the investment bank. But she is joining his campaign, so Cruz had to get insurance for his family of four, including two young daughters, through his employer — the the U.S. Senate.

If Cruz takes the employer contribution, the move would save the Republican Texas senator and his family thousands of dollars. Even if he doesn't take it, which is unclear at this point, he would still save through the federal exchange compared to signing up directly through a private insurer.

While the law's supporters will relish the irony of one of the most prominent opponents having to sign up, Americans continue to view the law more negatively than positively.

Out of 54 times the Kaiser Family Foundation has asked whether people have a favorable or unfavorable opinion of the law, Americans have only viewed it more positively than negatively eight times. The last time that was the case was November 2012, the month of Obama's reelection.

Since then, it hit a peak unfavorable view of 53 percent in July of last year. In the last several months, the law has migrated back to what has been its homeostasis – a split with the law being viewed slightly more negatively than positively. The latest poll this month, shows a 41 to 43 percent favorable to unfavorable view.

In addition to the public opinion challenges the law has faced, there are also the legal ones. The Supreme Court will decide a major case later this year that could decide the future of the law. At question is the constitutionality of state-based subsidies. Conservatives have challenged whether the way the law is written allows people who sign up in states through federal exchanges are actually allowed to do so.

Largely because of opposition in states with Republican governors, just 16 states have set up their own exchanges; seven others have hybrid exchanges that the federal government operates. The 27 states, where the federal government is the only option, account for a significant majority (59 percent) of the uninsured, according to data from the Pew Research Center.

That means if the subsidies are deemed unconstitutional, premiums could skyrocket and effectively gut the law.

At the same time, there is a challenge emerging for Republican opponents of the law.

While more people consistently view the law negatively than positively, almost two-thirds (64 percent) of Americans also said that if the subsidies are stripped out, they want Congress to fix the problem, per a Kaiser poll.

Even if the law survives what's sure to be a another close Supreme Court ruling, it will also have to get through a presidential election.

Several potential Republican candidates – and the one declared candidate, Cruz – are going to be hammering the law through another long, slog of a GOP primary season.

"We've made our share of mistakes since we passed this law," Obama conceded Wednesday, "but we know beyond a shadow of a doubt that the policy has worked."

But, as he recedes into lame-duck status during his remaining time in office, it will be up to Hillary Clinton, the likely Democratic standard bearer in 2016, to sell that message, preserve Obama's signature law, and, with it, his legacy.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.

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