That's one reason I'm thinking that the ACA may not succeed over time. Not because of the structure or nature of the legislation, but because those in opposition are communicating a stronger message more consistently than those who are trying to implement health care reform. Don't misunderstand me; I didn't say the opposing voices were accurate or objective about the legislation, I just said they were more consistent in their message. 

Our president and advocate-in-chief isn't concerned. In his latest weekly presidential address, President Obama said he's not worried that the forces aligned against him will kill the law. The president noted that history in general is kind to major legislation, that people similarly fought the creation of Medicare and Social Security, and those pieces of legislation still succeeded over time.

But this time there's a difference. Political opposition to the ACA is still as strong as ever, more than three years after it was signed into law.

Proponents have believed that the ACA would follow the same pattern as prior significant legislation: once those earlier efforts became law and the public saw the benefits, the opposition faded away. However, that was before the explosion of cable channels and the twitterverse created random news patterns, and the resultant emergence of the "echo chamber" that resonates on both ends of the political spectrum. 

Tick.  Tick.  Tick. We're down to the last few months before the real core of the law – the opening of the marketplaces – comes on line, and the general public still doesn't "get it."

Surveys by the Kaiser Family Foundation show little movement in the "likes" and "dislikes" about the law over the months and years since it was signed into law. That shows that the administration's task in launching the health care law — the biggest new social program since the creation of Medicare in 1965 — is harder than anything its predecessors had to face.

How tough is it? In the few short weeks between now and Oct. 1, the Obama administration has to get ready to enroll millions of people, and it has to put the infrastructure in place and get the health care industry up to speed on what is needed.

It also has to deal with battling Congress for money, persuading Republican governors and legislatures to go along, and placating well-funded and strident outside groups.  At the same time, there are international issues clamoring for attention and the beginnings of the 2016 presidential race. Quite a chess game.

Starting right now, the administration has a huge communication battle ahead.  The opportunities for early victories will come in the states that actually are making an effort – Maryland, Nevada, New York, etc.  The challenges will come in the states that are choosing to oppose everything, and those states that will not expand Medicaid.

And, this will not be on a level playing field. Last month I was fortunate to talk with a controller from Health and Human Services at a CPA conference.  Their insight? The sequester has had a significant negative impact on hiring – and that the background staffs that are crucial to a smooth implementation are thinly staffed and getting thinner.

Want an example?  These staff are the ones implementing the "data hub" needed to check people's eligibility for coverage, a key administrative part of the system.  The data hub, which is supposed to allow real-time checks of a customer's income and other information, is one example of a logistical problem that will get an even harsher spotlight because of the ongoing Republican resistance.

A recent report by the HHS inspector general's office said that because of all the delays, the official security authorization for the hub is now expected on Sept. 30 — one day before enrollment begins. 

Technology is involved – nothing can go wrong …

What to do?  Pay attention in the next few months.  As the ACA administration system rolls out and comes on line, watch what happens when there are hiccups in the complex systems, and what the reactions are to the problems in the media.  The side that wins the next communication battle will win this war, over time. Who knew that benefits communication was going to be so important?