By next Jan. 1, most people will be required to have insurance. States have to set up exchanges by Oct. 1, when uninsured individuals can start buying subsidized private health coverage that would go into effect Jan 1, and businesses with more than 50 employees working 30 or more hours a week were supposed to offer affordable healthcare to their workers or risk a series of escalating tax penalties.
But businesses said they needed more time, and on July 2, President Barack Obama's administration abruptly extended the deadline one year—to Jan. 1, 2015.
That caused some Democrats in Congress to worry the program would not be ready on time, as states are building online platforms for their residents to use to comply with the law. Although the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act in June 2012, the Republican-controlled House has voted 40 times since Obama signed the law in 2010 to repeal, defund or scale it back, most recently Friday.
As Congress prepared to head home for a five-week recess, Obama sought to calm jittery Democrats, assuring them that they are "on the right side of history" despite problems with the law's launch.
Republicans have stated openly they plan to use the slow economic recovery and the healthcare law to attack Democrats in the 2014 congressional elections.
But Iowa Gov. Terry Branstad, a Republican, said GOP governors could get blamed next year, even if they worked to meet its requirements, a situation that could be aggravated by Republicans in the U.S. House who continue to hold votes to attack it.
"My approach is not to complain about things, but to get it done best we can," said Branstad, who has been a vocal critic of the law. "It's our responsibility."
Wisconsin Gov. Scott Walker, the governors' host and a possible 2016 Republican presidential prospect, said Obama delayed the employer mandate out of fear that voters would blame Democrats in the 2014 elections if the economy suffered as a result of the new law.
"A cynic would be right to say the reason they pushed back the employer mandate had little to nothing to do with policy and everything to do with politics," Walker said.
Most of the two dozen governors from both parties gathered at the conference expressed confidence that their states would be ready on time, especially Democrats, although they said the work is daunting.
"Any time you go and make this much change in this short a period of time, it does cause headaches," Colorado Gov. John Hickenlooper said.
But with that pain comes progress, Hickenlooper and others argued. And those Republicans who have resisted or delayed taking action will pay the price.
Long before election day, the philosophical debate over the bill will have turned into a practical reality for millions of newly insured voters.
"Choosing ideology over jobs and affordable healthcare is a false choice, and it's an example of the differences between Republicans and Democrats," Vermont Gov. Peter Shumlin, a Democrat, said.
Among the challenges states are encountering are the technological requirements to allow buyers to search for insurers, rates and benefits on the exchanges. Others are training state employees to administer the program and marketing it to millions of Americans, all during a time of strained state budgets. Marketing employees were often among the first to lose their jobs.
Despite the headaches, the alternative to the status quo is far worse, Maryland Gov. Martin O'Malley said.
"Nothing could be more complicated than doing what we were doing before, which was to throw away more and more money on more expensive care for worse results," said O'Malley, a Democrat also mulling a 2016 White House run.