WASHINGTON — When President Barack Obama signed the Affordable Care Act five years ago, he visualized a time when the political hyperbole would be silenced and ordinary people would see that the health care law improved their lives.
The White House ceremony on March 23, 2010, was an applause-filled celebration. "When I sign this bill," Obama said, "all of the overheated rhetoric over reform will finally confront the reality of reform."
But the polemic around "Obamacare" hasn't cooled much, and the permanence of the president's achievement remains in question as the nation awaits the outcome of a Supreme Court case that could jeopardize insurance for nearly 8 million people.
Here's a look at the health care law, then and now:
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Then: 49.9 million people were uninsured in 2010, according to the Census Bureau.
Now: That's down significantly, to somewhere between 30 million and 40 million people.
The administration recently estimated that 16.4 million adults have gained insurance since the law's coverage provisions took effect.
Measuring differently, data from a large daily survey called the Gallup-Healthways Well-Being Index suggests a more modest impact: The uninsured rate dropped from 16.3 percent in early 2010 to 12.3 percent this year among adults 18-64, which translates to about 9.7 million fewer uninsured.
But the law's precise impact may not be clear for a few years, partly because census surveys take time.
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Then: Insurers could deny coverage to people with health conditions or charge them higher premiums.
Now: Insurers can't ask about someone's medical history. But they can charge smokers more.
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Then: Health insurance was available to most people, but the government didn't require them to have it.
Now: The law requires nearly all Americans to have coverage, either through an employer, a government program or by buying their own policies. The uninsured risk IRS fines.
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Then: In April 2010, 46 percent had a favorable view of the law, while 40 percent had an unfavorable opinion, according to the Kaiser Family Foundation tracking poll.
Now: Naysayers have an edge. Forty-three percent have an unfavorable opinion, while 41 percent have a favorable view, according to Kaiser's latest poll.
About 3 in 5 said the law has had no impact on their family. The rest are divided almost equally between the 19 percent who said they were helped and the 22 percent who said they have been hurt.
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Then: Democrats ran both chambers of Congress. Nancy Pelosi was speaker of the House and Harry Reid was Senate majority leader.
Now: Republicans are back in charge after Democratic losses in the 2010 and 2014 midterm elections. Opposition to "Obamacare" was a motivator for conservative voters. Pelosi and Reid are minority leaders in their respective chambers.
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Then: Losing health insurance was a rite of passage for young adults; insurers routinely dropped them from parental coverage.
Now: Young adults can remain on a parent's plan until they turn 26, whether or not they are students.
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Then: People who bought their own health insurance had to pay the full cost — making it unaffordable for many.
Now: Insurance exchanges like HealthCare.gov offer subsidized coverage.
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Then: The final legislation cut a provision that would have authorized Medicare to pay doctors for counseling patients about what kind of care they would want in the last stages of a serious illness.
Former GOP vice presidential candidate Sarah Palin asserted that would lead to "death panels." Palin's accusation was widely debunked, but not before it created a furor.
Now: Medicare is considering a regulation to allow payment for end-of-life counseling and has asked for public comment. Such counseling would be voluntary, and the idea has wide support in the medical community.
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Then: At a rally near Cleveland days before the bill passed in 2010, Obama claimed employers would see premiums plummet, "which means they could give you a raise."
That year, annual premiums for employer-sponsored insurance averaged $5,049 for employee-only coverage and $13,770 for a family plan, according to the Kaiser Family Foundation's employer survey.
Now: Premiums for job-based insurance have gone up.
They averaged $6,025 for employee-only coverage in 2014, the most recent year available from Kaiser. Family coverage averaged $16,834. The employee share also went up.
Supporters of the law say premiums have risen more slowly than would have otherwise been the case.
But employers have kept shifting costs to workers. The average annual deductible for single coverage was $1,217 in 2014, up from $917 in 2010.
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Then: The 2010 Medicare trustees report estimated that spending cuts and tax increases in the health care law would extend the life of the program's giant hospital trust fund to 2029. Before, it was expected to run out in 2017.
Now: The 2014 Medicare trustees report estimated that the trust fund will be exhausted in 2030. Slowing medical inflation has helped Medicare, even as baby boomers reaching age 65 are flocking to enroll.
The health care law's cuts haven't had the dire consequences that many seniors feared. Congress has passed even more spending reductions since 2010.
Medicare's long-term future remains uncertain.
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Then: Even before Obama signed the law, conservatives were preparing a constitutional challenge to its requirement that individuals carry health insurance. A divided Supreme Court upheld the mandate in 2012, ruling that the penalty for not complying works like a tax. However, the court gave states the option to reject the law's Medicaid expansion.
Now: A decision in the latest case brought by opponents is expected in late June.
