The troubled U.S. healthcare industry, recently a problem for Democrats facing voter anger over President Barack Obama's overhaul law, is now plaguing Republicans hoping to take the White House in 2012.
The health law proved a liability for Democrats in the November 2010 elections as Republicans surged to big victories in Congress by labeling it and other Obama-backed programs as the heavy-handed intrusions of big government.
But unhappiness over healthcare has now begun to infect Republicans seeking their party's presidential nomination — particularly concerns about Republican efforts to revamp Medicare, the popular healthcare program for older Americans.
"Republicans have been so brilliant at framing what should have been a great Democratic success as too much government," said James Morone, an expert on politics and healthcare policy at Brown University in Rhode Island.
However, he added: "It's much harder to argue against big government when you're targeting popular programs.
So they have a rather tricky argument to make." The Republican most prominently caught in the debate has been Mitt Romney, considered a front-runner in the nomination race, who has struggled to separate himself from the state healthcare plan he crafted as governor of Massachusetts, dubbed "Romneycare" by the same conservatives that derided the president's revamp as "Obamacare".
Obama has cited the Massachusetts program as a model for the federal healthcare law he steered through Congress in March 2010.
Similarities between the two programs are seen as the biggest challenge to Romney's presidential ambitions.
"The debate over Obamacare and the larger entitlement state may be the central question of the 2012 election," the Wall Street Journal wrote in an editorial slamming Romney on May 12, the day Romney gave a speech seeking to draw distinctions between his plan and Obama's.
"On that question, Mr Romney is compromised and not credible.
If he does not change his message, he might as well try to knock off (Vice President) Joe Biden and get on the Obama ticket," the newspaper wrote.
Furor Over Medicare
Opinion polls show a broader problem for Republicans is the party's push for cuts in Medicare, particularly a proposal by Congressman Paul Ryan to turn the fee-for-service plan into a program of vouchers that the elderly would use to purchase subsidized health insurance from private insurers.
The Republican budget plan passed by the House of Representatives last month would repeal the Obama healthcare law, scale back spending on the state/federal Medicaid healthcare program for the poor and implement the plan from Ryan, chairman of the House Budget Committee.
With polls showing two-thirds of Americans prefer to keep Medicare in its current form, Democrats have been rushing to take political advantage.
The Democratic Congressional Campaign Committee has begun making automated calls about the Medicare plan in 20 districts.
And party leaders are seeking to make a special congressional election in New York on May 24 a referendum on the Republican Medicare plan.
"Candidates already are capitalizing on this issue and using it to say Republicans are outside the mainstream," said Darrell West of the Brookings Institution think tank.
The issue has caused a rift among Republicans. Newt Gingrich, the former House speaker who launched his bid for the presidency last week, called Ryan's plan "right-wing social engineering" and said there were other ways to save money from a program struggling with skyrocketing healthcare prices.
Ryan and other Republicans have struck back at Gingrich, saying he misunderstood the Ryan plan. Gingrich also expressed support on a Sunday television show for the individual mandate, a core provision of the Obama healthcare law that requires individuals to purchase health insurance.
The mandate has enraged Tea Party activists and has drawn legal challenges from opponents who say the government has no right to force Americans to buy insurance.
But in an about-face on Monday, Gingrich's campaign issued a statement saying he is committed to completely repealing "Obamacare." Democrats have responded with glee to the Republicans' infighting, but they still face a tough fight convincing the public to embrace Obama's healthcare law, well over a year since it passed, apart from the pending legal challenges.
Public opinion is split, with 41 percent of Americans favoring the law and 41 percent opposed, according to a Kaiser Family Foundation poll.
Morone said that if Democrats want to win the healthcare debate, they must convince Americans they will benefit from plan provisions, such as the ability to keep their children on their health policies until they are 26.
"Republicans want to say 'This is big government run amuck.' That has always worked for them, and unless the Democrats get very specific, it will always work for them."