'Obamacare' rejection could bring failure in November
This week the US Supreme Court will hear oral arguments by supporters and opponents of Barack Obama's top domestic policy achievement so far - healthcare reform.
But, irrespective of how the court rules regarding its constitutionality, the court of public opinion has already given a major thumbs-down to 'Obamacare'.
According to an ABC/Washington Post poll last week, Americans oppose 2010's Affordable Care Act (ACA) by a 52% to 41% margin; 67% said they favoured either dropping key provisions or scrapping the law altogether.
It isn't exactly a bolt out of the blue that the ACA is unpopular. When Obama began his drive for a healthcare overhaul in 2009, opponents were ready to pounce.
The result was a hysterical public debate, where distortions and outright fabrications by reform opponents resulted in fears that Obama was readying death-panels to kill off the old and sick.
The insurance firms, aided by the US Chamber of Commerce, deserve a sizeable amount of the credit, or blame, for the fear-mongering. During the run-up to the law's 2009 congressional passage, the insurance industry and the USCC spent $86m opposing it.
Full implementation of the ACA will mean that 32 million people who didn't have insurance in 2009 will eventually be covered (leaving about 18 million still uninsured).
That will happen, in part, through an expansion of the government-run Medicaid, which previously has primarily covered the disabled and elderly poor.
The ACA also allows children to remain on their parents' insurance until the age of 26 and prohibits insurance companies from denying coverage to people with pre-existing conditions.
These last two elements are extremely popular with the public and some observers feel they may survive - even if the Supreme Court strikes down other aspects.
The most contentious aspect is the individual mandate, or the requirement that anyone without insurance must either find employment that gives them it, or purchase a plan themselves by 2014 or face a fine.
And this is the main point on which the 26 states that are party to the case before the Supreme Court are banking on for victory.
They say that Congress had no right to pass such a mandate, because it violates constitutional restrictions on Congress meddling in interstate commerce. Obama and the Democrats say that is nonsense and there are plenty of precedents for Congress doing so.
Another reason why the ACA is unpopular is that many insured people see it as the reason why their premiums are skyrocketing.
That's because the insurance industry claims that, in order to provide the expanded coverage mandated by the ACA, they've no choice but to hike rates.
Insurance industry critics say it's crying crocodile tears. They says rates are spiking because insurance companies are trying to make health reform seem economically painful and thereby increase public anger at the reforms.
Critics on the Left say that Obama has only himself to blame for the lack of public support for the ACA. They accuse him of not seeking a stronger overhaul to begin with and, hence, not allowing himself a stronger fall-back position that would have delivered more substantial systemic change.
But that is all water under the bridge. What matters for Obama now is that he faces the very real prospect of a conservative Supreme Court scrapping his main domestic policy victory.
That would make achieving victory over his Republican rival that much harder in November.