In neighboring Missouri, an insurance company's campaign to get small businesses to sign up by taking advantage of new tax breaks has yielded mixed results.
One of the chief promoters of the idea is Ron Rowe, an executive of Blue Cross and Blue Shield of Kansas City. With some 150 previously uninsured businesses offering new coverage, his company's efforts earned the praise of Obama administration officials. But Rowe says many business owners found the math didn't work for them.
"The longer this has been out in the marketplace, the less appealing it's been to small-business owners," he said. A typical employee with 10 workers would have to pay about $31,000 a year for health insurance and recover only 10 percent to 15 percent of that through the new tax credit.
Rowe says his company is getting more interest from business owners by offering a cap on rate increases.
No group is more sensitive to medical costs than senior citizens, whose votes are also critical to Democrats' chances in the 2012 presidential election. So far, alarms that Medicare cuts would compromise their care have not been borne out. But Democratic lawmakers engineered the cuts to take effect gradually, while new Medicare benefits are being provided now.
Topping the list this year is a 50 percent price cut on brand-name prescriptions for Medicare recipients who fall into the coverage gap called the "doughnut hole." Daniel Wisniewski, a retired truck driver from Staten Island, N.Y., reckons that will reduce the price of one of his heart drugs from $234.99 a month to around $117.
"I'm not much on politics, but I feel that that's got to help me," said Wisniewski, 69. "I worked and paid into Social Security for 55 years. When I was a kid I used to wash dishes in a bakery after school."
Republicans say such gains will be temporary. For families, "any marginal benefits from this law are far outweighed by the heavy-handed intervention in their health care by Washington bureaucrats," said Sen. Orrin Hatch, R-Utah.
Affordability is the main worry for critics. A recent poll by the nonpartisan Kaiser Family Foundation found that one in five Americans said they had been negatively affected by the law, and about half of those cited costs. Some blamed the law for this year's premium hikes, although many experts say the impact was marginal.
"If they have a bad experience in the marketplace, it's very possible they're going to attribute that to the law," said Mollyann Brodie, Kaiser polling director. "It certainly presents a challenge for the proponents."
A lead author of the bill, Democratic Sen. Max Baucus of Montana, remains a strong supporter but laments not devoting more attention up front to cost control. "It gave detractors an opening," he said.
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