A "big f***ing deal" has become an equally big fight, with Republicans relentlessly attacking President Barack Obama's signature health care reforms over the new reality they are bringing to the health insurance market.
One reason is the GOP's ideological opposition to big government, as manifested by the health care overhaul intended to hold down rising costs that threaten U.S. fiscal stability.
Another is the long-term political benefit to Obama and Democrats from the sweeping changes intended to give people previously unable to afford health insurance or deemed ineligible the chance to obtain coverage.
Coupled with Obama's stated second-term priority -- proposed immigration reform that would remove the "illegal" label for millions of undocumented aliens -- the legislative power play could provide an electoral boost for Democrats certain to last a generation or longer.
The combination of Obamacare -- as the 2010 Affordable Care Act is known -- and immigration reform "would be a huge boon to the Democratic Party," said Darrell West, the Brookings Institution's vice president and director of governance studies.
"It would provide insurance to millions who don't currently have it, and it brings aboard undocumented people who are very likely to be Democratic supporters," he told CNN.
Wendy Schiller, a political science professor at Brown University, said such an outcome is the goal of all presidents and their congressional allies who seek to "enact policies that will hold their base and attract new voters in successive election cycles."
Republicans know that, which explains their fierce opposition to Obamacare dating back to well before Vice President Joe Biden's off-color description whispered too loudly to Obama as the President prepared to sign the law in 2010.
Now a confluence of factors -- including the overall impact of the reforms as well as major problems in their implementation and continued GOP efforts to derail them -- have further hardened already entrenched partisan positions on the issue.
Effects of Obamacare
It has taken more than three years since the Affordable Care Act became law to begin to understand its effects.
The concept leans heavily on a conservative Republican idea adopted for the Massachusetts state health care program that creates large markets to hold down prices. To work, the program must include less-expensive young people to offset the higher costs of older people, who generally need more health care.
Such a system would provoke competition between insurers for lucrative markets, meaning lower premiums and a minimum standard of benefits to provide security against financial ruin over a major illness or bad accident.
However, an analysis by CNN found that consumer options vary significantly from state to state, and many Americans are discovering they have few options.
For example, West Virginia and New Hampshire have one insurance company offering coverage, meaning no choice between providers, while eight other states -- Alabama, Alaska, Hawaii, Maine, Mississippi, North Carolina, Vermont and Wyoming -- have two.
The Kaiser Family Foundation estimates that 12 million people live in counties with only one insurer, compared with 117 million in counties with more than five insurers. The foundation's Cynthia Cox found that in counties with more than five insurers, the average premium was about $20 a month less than in areas with only one insurer.
In addition, CNN's Tom Foreman reported Thursday that in some cases, the same company will charge more for a policy in a rural area, compared with a big city.
The differences generally reflect the smaller pool of consumers in less populous rural areas, compared with more densely populated urban and suburban areas.
Such disparities also tend to follow a political fault line in many places, with Democrats more prevalent in big cities and suburbs, while Republicans generally get more support in rural areas.
While definitive correlations would be overly simplistic and premature, increased options in urban areas versus rural areas indicate that on a broad level, more Democrats than Republicans are realizing benefits from Obamacare so far in terms of choice and cost.
To Jonathan Gruber, a Massachusetts Institute of Technology professor who helped design the Massachusetts and federal health care laws, it is too early to understand the full effects of Obamacare.
"It's not like Obamacare's chasing insurers out" of rural areas, Gruber told CNN on Thursday. "These are just markets that didn't have many insurers to choose from before, and there hasn't been a lot of entry in the recent times since the law has passed."
In Massachusetts, he said, a major new provider entered the market two years after the reforms took effect.
"You don't need 16 choices. You don't need 12 choices," Gruber said. "It's nice to have that many, but having one or two new entrants, which will happen over time -- it did in Massachusetts -- can really shake up the market in lower prices."
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