Landrieu has gone on the offensive, too, criticizing Louisiana Gov. Bobby Jindal and her state's Legislature for refusing federal money to broaden Medicaid insurance for more low-income Americans. Along with the exchanges, the optional Medicaid expansion anchors the law's insurance coverage extension.
With those contentious parts slated to begin next year, Obama's signature legislative achievement is all but certain to be central in the 2014 midterm campaign as Republicans look to hang onto power in the House and gain the six seats they need to win control of the Senate for the final two years of the Democratic president's second term.
A Republican-aligned outside group already has aired a TV ad in Arkansas deriding Pryor as "the deciding vote for Obamacare" — a label Republicans can apply to any Democrat since the bill passed with the exact number of votes necessary to avoid a GOP filibuster. The North Carolina GOP regularly hammers Hagan on her choice. And Louisiana Republicans recently tried to link Landrieu to comments from the state Democratic Party chairwoman, who suggested that opposition to Obama's law stems from the fact the president is black.
Initially, the law's 2010 passage roused tea party activists, who propelled Republicans to a House majority and Senate gains that fall. The lagging economy and anger over bank rescues, stimulus spending and budget deficits also played a role. Reprising the health care critique as part of their 2012 strategy, Republicans couldn't replicate their success: Obama defeated Romney decisively, and every Senate Democrat who voted for the health care law won re-election.
Public support for the law as a whole has never consistently reached a majority, according to most polls; opposition in Romney-won states exceeds 50 percent. Yet many individual provisions already in effect, like those Begich mentioned, have more support in polls.