The Supreme Court's dramatic decision to uphold the Affordable Care Act gives President Barack Obama a major political victory. But the controversial measure now becomes a major election issue and its future will remain in doubt at least until voters render their verdict this November.
That's because presumptive Republican nominee Mitt Romney has pledged to scrap the plan Obama hopes will become his lasting political legacy, something he would be in position to do if he unseats the incumbent and fellow Republicans keep the House and win the Senate.
"If we want to get rid of Obamacare, we're going to have to replace President Obama," Romney declared after the decision, denouncing the plan as "a job killer" that would raise taxes and increase the deficit, and vowing he would do on the first day of his presidency "what the court did not do."
On the other hand, Thursday's 5-4 decision means that an Obama re-election victory would probably ensure that the plan enacted after a bitter 15-month battle remains on the books, despite continuing resistance by congressional Republicans and many GOP governors.
Similarly, a split electoral verdict in which Democrats at least retain the Senate will make it harder for a Republican president to scrap the plan, though he might be in position to change and possibly cripple it.
Obama called the decision "a victory for people all over the country whose lives will be more secure because of this law," citing specific benefits like those protecting people with pre-existing conditions and warning critics against refighting the political battles of two years ago.
He acknowledged that, even if he wins, the plan likely will face changes over time. In fact, no one really knows how its complex details will work, and it also remains unclear if it will succeed in slowing the soaring costs of health care as the goal of universal coverage is pursued.
Conservative critics had counted on the court's five Republican appointees to reject the measure's key mandate requiring all Americans to purchase health insurance through private companies, regional networks or a federal alternative or be subject to a payment.
Ironically, the court appears to have given Romney an additional campaign weapon to use against Obama by defining the required payment for those forsaking insurance as a tax. Republicans immediately noted that Obama had promised his plan would not raise taxes on middle-class Americans.
In the end, despite feverish rhetoric by critics, any hope of getting rid of the Obama plan now rides almost totally on the election results. But the nation still faces major health care issues, and Thursday's decision makes it more likely that Obama's Affordable Care Act will be the vehicle to deal with them.
Carl P. Leubsdorf is the former Washington bureau chief of the Dallas Morning News. Email: firstname.lastname@example.org.