Rather than political or legal arguments determining its fate, it's likely the healthcare overhaul will succeed or fail based on the reaction of millions of Americans in search of coverage.
"Let me remind everybody that the Affordable Care Act is not just a website. It's much more," Obama said this week as he took the lead in his administration's efforts at damage control over the major online problems in the programs' first signup month. He said that because of the law, which has been taking effect in stages for three years, "preventive care like mammograms and birth control are free through your employers," young people up to age 26 can remain on their parents' coverage plans and some seniors are paying less for their prescription drugs.
Republicans skip over any well-received benefits the law might have bestowed. Instead, they speculate that the website is a gateway not to healthcare coverage but to bigger and more painful failures in the near future.
"Will enrollment glitches become possible provider payment glitches? Will patients show up at their doctor's offices or hospitals to be told that maybe they aren't covered or even in the system?" asked Rep. Fred Upton, R-Mich., as he chaired a hearing of the House Energy and Commerce Committee on Thursday.
Democrats were having none of it, even though they express their own frustration and anger at the debut of the website.
"Here we go again, another cynical effort by the Republicans to delay, defund or ultimately repeal the Affordable Care Act," said Rep. Frank Pallone, D-N.J., speaking at the same hearing. "Their effort, obviously, isn't to make this better but to use the website and the glitches as an excuse to defund or repeal Obamacare."
Ironically, the roles were reversed a decade ago, when the Bush administration struggled to implement a new prescription drug benefit under Medicare. Many Democrats had voted against the change and harshly criticized it, yet they failed to turn it into a winning issue in 2004.
At some point, Obama may yet find himself agreeing to major changes in the law.
There is growing Democratic sentiment inside Congress for a one-year delay in the requirement for individuals to purchase coverage, given the difficulty with the website. Senators on the ballot in 2014 are notably nervous. Support inside both parties is strong for repealing a medical device tax contained in the law.
For now, though, the focus is the website, a problem the administration insists it can and will fix.
Republicans' decision to seize on the flawed roll-out comes as the party is desperate to shift the public's attention away from the recent partial government shutdown and the clash over the debt ceiling, and resurrect an issue they hope will benefit them in next year's elections.
No wonder, since every new poll seems to bring more bad news for the GOP.
Among them was a finding in a recent Washington Post-ABC survey that only 20% of those questioned said Republicans are generally interested in doing what's best for the country, with 77% saying the GOP is acting out of political self-interest. The 20% figure drops to 14% among independents, who probably hold the key to victory in next year's midterm elections.
Nor are Obama and congressional Democrats alone in discerning purpose in the law, a major part of which allows states to expand healthcare to the poor by easing income restrictions under Medicaid.
After a long struggle, Republican Gov. John Kasich of Ohio prevailed this week over inter-party critics in the Legislature, and his state became the latest to agree to the expansion. "We've improved both the quality of care from Medicaid and its value for taxpayers," he said in a statement.
Republican governors in Arizona, Michigan, Pennsylvania and elsewhere have backed the Medicaid expansion in their states, often over opposition from critics aligned with the tea party.
Funding for the expansion comes entirely from the federal government for the first two years. Even so, several Republican governors and legislatures have chosen to decline it, saying it would inevitably lead to a financial burden on their states in future years.
Nor have Republicans yet offered an alternative to the law, even though they campaigned on a platform of "repeal and replace" in 2010. Efforts to formulate a different approach have been thwarted in significant part by conservative critics who insist anything short of full repeal is unacceptable.
Yet in the wreckage of the shutdown struggle, there are hints of a grudging Republican recognition that the law may survive.
Despite their long-held positions against government mandates, House Republicans voted during the recent faceoff with Obama to leave in place some of the politically popular provisions they have strenuously opposed in the past.
Among them is a pair of requirements that the president cited in his remarks this week. One is a requirement for insurers to cover individuals with pre-existing conditions, and another allows young people up to age 26 to remain on their parents' plans.
Neither required a website before taking effect.
