A SIGN OF HISTORY: U.S. President Barack Obama signs the landmark Patient Protection and Affordable Care Act at the White House on March 23 (CFP)

U.S. President Barack Obama finally signed the Patient Protection and Affordable Care Act into law on March 23, capping his grueling, year-long pursuit of an overhaul of America's dysfunctional national health care system. To mark the occasion, he passed out the pens he had used to sign the legislation as mementos to aides and lawmakers alike.

But the ease of his brush strokes and his obvious pleasure at the accomplishment—a hallmark of his presidential campaign—will continue to face the harsh realities of highly partisan Washington politics for months and years to come.

The act will extend health care to some 32 million additional Americans—making health insurance available to 95 percent of the U.S. population. The United States previously stood alone among industrial nations as the only country to not extend any health care coverage to a majority of its citizens.

But opponents of the plan, largely consisting of Republicans, are continuing to block the measure. They have renewed their vows to repeal the act by playing up the most contentious aspects of the reform. The act, for instance, requires every U.S. citizen to purchase health insurance against the risk of being fined. According to its opponents, this provision is unconstitutional.

Many American states have voiced support for the Republican challengers—with 36 of them threatening to boycott Obama's new package outright. Of equal importance, the U.S. Supreme Court has yet to make a clear stance on the issue. All this has cast a long shadow over the future of Obama's health care reform.

A bold move

These factors have widened the already partisan divide in U.S. politics that has only sharpened since Obama became president in January 2009. This was underscored by the fact that every Republican lawmaker in the House of Representatives voted against a package designed to reconcile differences between the bills approved, respectively, by the Senate and the House of Representatives on March 21.

In the end, the package was passed by a vote of 220 to 211—a remarkable margin given that both Houses of Congress are dominated by Democrats.

Republican politicians have openly asserted that the plan would lead to spiraling insurance costs, job losses, heavier tax burdens and poorer overall medical services for the public.

Even before ascending to the Oval Office, Obama repeatedly expressed his hope for "post-partisan" solution to the American health care crisis. A year later, however, he has proven unable to bring the Republicans into the fold. In their stated view, Obama sidestepped them and manipulated the Democrat-dominated House and the Senate to his advantage.

The Republicans have clearly decided to retaliate. The Republican party has promised to challenge the Democrats on a series of critical issues within the legislation itself, thus complicating prospects for long-term, comprehensive reform.

Although the adoption of health care reform should be regarded as a significant breakthrough in its own right, the U.S. public and media outlets have not shown sufficient interest.

Instead, the American media and its pundits have proclaimed the passage of the legislation as more of a symbolic move, while voicing skepticism as to whether any of it can be effectively put into practice.

Indeed, its prospects for success appear uncertain: Many Americans have said they would not accept health care changes that could raise taxes or lead to an increase in the nation's already staggering budget deficit.

Against this backdrop, it remains unclear what effects health care reform may have on U.S. voters in the upcoming midterm elections—let alone in the presidential elections two years from now. Even if there is a positive outcome for the White House, the reform is unlikely to be a decisive factor in a second term for the Obama administration, largely due to the time it will take for the changes to take effect—and, more importantly, the ever-worsening state of the economy.

But whether true health care reform will ever materialize hinges on the public and the governments of the states in which they live. This has been behind Obama's strategy of traveling nationwide to make his case to the American people and their local and state representatives.

At the same time, he must also try to narrow the gap between the Democrats and the Republicans on Capitol Hill.

Daunting as this may be, Obama can hopefully win over some of the opposition. His dogged determination to pursue the reform—even at the cost of a second term—in itself represents a reason to convince others.

Moreover, the heath care reform he signed into law contains plenty of advantages for the nation with the most expensive—and inequitable—health care system in the world. The major advantage is that it expands health insurance coverage nationwide from around 85 percent to 95 percent—very close to full universal coverage.

More importantly, Obama has targeted America's increasingly unaffordable, highly bureaucratic and often inefficient medical system. Although the United States leads the world in areas such as research and development—particularly for pharmaceuticals—the fact that a vast majority of working Americans are wholly dependent on employer-based health insurance has all but strangled a significant portion of the economy.

But far worse are widely held assessments that some 30,000 Americans die every year because of a lack of health coverage.

The present system often encourages hospitals and medical professionals to provide redundant forms of treatment—not limited to excessive lab tests and expensive medicine. The reform bill promises to reduce such practices.