Despite opponents, the ACA's start is a proud moment

At midnight on New Year’s Eve, the United States fulfilled a resolution that went unkept in many earlier years. It finally did something to increase access to health care, to make it more affordable to low- and middle-income people and to hold down the relentless escalation of health care costs.

On Jan. 1, nearly four years after President Obama signed his greatest accomplishment into law, the Patient Protection and Affordable Care Act took effect. And that has given this new year something truly new. No more can people be denied insurance because of pre-existing conditions, can older people be charged much higher premiums than younger people or can women be charged more than men. And insurance companies must now reveal more pricing and benefits information to their customers.

The arrival of the Affordable Care Act’s effective date made real the pledge that Obama made when he signed the historic measure with 22 pens on March 23, 2010.

“The bill I’m signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see,” Obama said, adding, “Today we are affirming that essential truth, a truth every generation is called to rediscover for itself, that we are not a nation that scales back its aspirations.”

At a time of frustrating gridlock in Congress and a general political polarization that often splits the nation and stalls its advance, it should be a cause for universal pride that a great national objective is now a reality.

But, of course, that is not the case. Most Americans still take a dim or skeptical view of the massive new law. That prevailing attitude is a product of constant fear-mongering by Republicans who insist that the ACA is or is bound to be ATW – a train wreck. Indeed, state Sen. Bob Rucho, a Mecklenburg County Republican, recently said via Twitter that the law will do more damage to the United States than “the swords of the Nazis, Soviets and terrorists combined.”

Fueled by such hysteria, Republicans in the U.S. House voted more than 40 times to repeal what they call “Obamacare.” Republicans challenged the law all the way to the Supreme Court. Most Republican-led states refused to set up a state-based health care exchange or to expand Medicaid despite provisions that would have the federal government pay for almost all the costs in the first three years and 90 percent thereafter.

Along with politics, technology further stymied the advent of the law as the federal exchange website Healthcare.gov went online with a flawed design and far more states to cover than anticipated.

All the opposition and technological glitches have battered the law’s image, but the challenges also give the measure a certain luster of tenacity in the service of need. In this, the law is a triumph in health care similar to the accomplishments of NASA in science. NASA put a man on the moon. The ACA has begun the process of getting health insurance to more than 45 million uninsured Americans. Reaching the moon and the uninsured are very different things, but both involved a great ambition, ingenuity, teamwork, technical prowess, persistence and, after setbacks, a launch.

Years from now when almost all Americans are insured and health care costs are understandable and contained, people will look back and wonder what all the fuss was about. The Affordable Care Act has its problems and its compromises, but it is on the whole a good and welcome new set of standards that will keep Americans healthier and make the nation better.