It has been 3 years since Congress passed the law that has become known as Obamacare. Implementation of the Patient Protection and Affordable Care Act (ACA) has been underway since the ink dried on the bill.

But if anyone thought that Congress passing, and then the U.S. Supreme Court sustaining, ACA meant that the fight over it had at last been settled, they would be mistaken. In the hyper-partisan political landscape that has prevailed in the U.S. for at least the last two decades, big issues may settle down for a time but they don’t remain settled for long.

Most of ACA’s provisions don’t kick in until 2014. The public’s experiences with the law will be grist for off-year Congressional election campaigns. It would be comforting to believe that because the major challenges to the new healthcare law have been adjudicated, everyone would just get about the task of making the best of the situation. That may be hoping for too much.

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