The Affordable Care Act survived a near-death experience at the Supreme Court earlier this year. And the overhaul law's fate again hangs in the balance come Election Day. Mitt Romney has vowed to work for its repeal, if he's elected president.
Meanwhile, the law continues to take its hits.
The latest come from the Congressional Budget Office and the state of Oklahoma. The former has issued a report that increases by 50 percent its estimate of how many people will ultimately pay a fine rather that purchase health insurance as required. And Oklahoma Attorney General Scott Pruitt has filed an amended lawsuit in federal court charging that an IRS rule to implement the law's subsidies exceeds its authority under the measure.
Oklahoma was in a unique position to amend its original lawsuit charging that the health law was unconstitutional because that suit had been stayed pending the Supreme Court's decision. Now that the issue of constitutionality has been settled, officials have decided instead to challenge the IRS rule that allows subsidies to be provided in health insurance exchanges run by the state or by the federal government.
Opponents of the law say those subsidies are allowed only in state-run exchanges, and that Oklahoma is one of the states unlikely to create one.
"Now that the Supreme Court has deemed the ACA a tax, and therefore constitutional, the federal government must follow the law and proper procedures, and that is not being done," Pruitt said.
Most Republicans, however, were quicker to react to the news from the CBO, which increased its estimate of how many people would end up paying the fine in the year 2016 rather than purchasing health coverage from about four million people in 2010, to about 6 million people now.
CBO said the larger number is due mostly to changes in its estimate of what will happen in the economy between now and 2016. The key factors are higher unemployment rates and lower salaries and wages.
That revision was red meat for Republicans, who say that the fine violates President Obama's 2008 campaign promise not to raise taxes for people with incomes under $250,000.
"If Americans knew that failure to comply resulted in a tax hike, it never would have passed," said Senate Minority Leader Mitch McConnell. "And now the non-partisan CBO makes clear that the tax will hit 6 million Americans—mainly middle-class individuals and families. This is just one more reason among many for why Obamacare must be repealed."