It was the biggest achievement of his first term, the national health care law that had eluded Democrats for 60 years. "A big (bleep)ing deal," in the blunt words of Vice President Joe Biden.
But it could help cost President Barack Obama a second term.
Rather than cheering it on, Americans are divided over the Patient Protection and Affordable Care Act, which he signed into law two years ago Friday. The Supreme Court is weighing whether it's constitutional. Republicans vow to repeal it if the court doesn't strike it down. And the White House is working overtime to sell the American people on the law, before it's too late.
It may still turn into a political triumph. Republicans, in fact, fear that if left intact, the law could take hold in the American psyche over the years, as Social Security and Medicare did generations ago.
For now, though, it hangs in the political balance, along with the fate of Barack Obama.
It wasn't supposed to be this way.
Obama won his 2008 election in part on the pledge to finally deliver what Democrats since Harry Truman had promised: universal health insurance. When he and the Democratic-led Congress finally delivered, the White House was giddy.
"Mr. President, you've done what generations of not just ordinary, but great, men and women have attempted to do," Biden gushed at the signing ceremony in the East Room.
Yet Americans were skeptical at best even then. They were turned off by the backroom deals in Congress needed to muscle the law through, confused by the mammoth bill that even sponsors admitted they hadn't read, and open to complaints from Republicans that it threatened the country.
"The Democrats were very ineffective selling it originally," said Lee Miringoff, the director of the McClatchy-Marist Poll and the Marist College Institute for Public Opinion in New York. "They lost the battle of the message early on. The tea party dominated early discussion of what this is all about."
Indeed, a backlash against the law helped fuel the rise of the tea party and the Republican landslide in congressional elections in 2010.
Republicans know that this year's elections may be their last best chance to stop the law, even as they're mindful of the history of Social Security and Medicare.
In 1936, Republican presidential candidate Al Landon campaigned against the Social Security law, enacted just a year before and not yet in effect. "Unjust, unworkable, stupidly drafted and wastefully financed," Landon called it.
He lost. Franklin D. Roosevelt won a landslide re-election, and Social Security grew to be so popular that it's become the subject of a maxim of modern politics: It's called the third rail of politics - after the electrified rail that powers subway trains - "touch it, and you die."
Republicans also initially opposed Medicare. "Socialized medicine," George H.W. Bush said in a 1964 Senate campaign. It was enacted anyway in 1965, and most Republicans supported it over the next several decades.
When Republicans occasionally have urged changes to Medicare, they've run into a wall of criticism from Democrats. In 1995, then-House Speaker Newt Gingrich proposed cutting Medicare's projected spending growth by $270 billion as part of a broad effort to balance the federal budget.
"Now, we don't get rid of it in round one because we don't think that that's politically smart, and we don't think that's the right way to go through a transition," he said. "But we believe it's going to wither on the vine because we think people are voluntarily going to leave it - voluntarily."
Sparked by Democratic ads defending Medicare, a public backlash helped Democratic President Bill Clinton win re-election in 1996.
Today voters are divided over Obama's health care law: not as supportive as Democrats would like, not as hostile as Republicans claim.
As the Supreme Court weighs the law's constitutionality next week, a new McClatchy-Marist poll finds that a majority of voters want at least part of the measure thrown out. Thirty-five percent want the entire law repealed, and another 21 percent want its mandate that everyone buy insurance - its fundamental core - thrown out.
Just 34 percent want to let the law stand as is, the national poll found.
Opposition is strongest among Republicans: Fifty-three percent of them want the entire law repealed, and another 29 percent want the mandate ruled out.
Independents, too, tilt against the law, with 63 percent of them favoring repeal of the entire law or the mandate.
Democrats support the law: Sixty-five percent of them say to leave it alone.
"The polling data suggest in part the hundreds of millions of dollars that was spent attacking it," White House press secretary Jay Carney said, speaking of all polling on the law. "What we're focusing on is implementing it so that more and more Americans see the benefits that it brings."
The Obama team is rolling out a broad campaign to sell the law, including dispatching Cabinet members, Democratic Party officials and celebrity supporters to talk up its benefits.
One angle: stressing benefits to blocs of voters, such as women, who are seen as crucial to the president's re-election.
Actress Eva Longoria, for example, went on MSNBC to argue that the law in 2014 will prevent insurance companies from charging women more for insurance than they do men.
"Women need to be educated," Longoria said, "on everything that Obama has done in his first term regarding their rights and access to health care."
The McClatchy-Marist survey of 1,080 adults was conducted Tuesday through Thursday. People 18 and older who live in the continental United States were interviewed by telephone. Phone numbers were selected based on a list of telephone exchanges from throughout the nation. The exchanges were selected to ensure that each region was represented in proportion to its population. To increase coverage, the land-line sample was supplemented by respondents reached through random dialing of cellphone numbers. The two samples then were combined. Results are statistically significant within 3.0 percentage points. There are 846 registered voters. The results for this subset are statistically significant within 3.5 percentage points. The margin of error increases for cross-tabulations.
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