Massachusetts provided the blueprint for President Obama's 2010 federal health care law, but in the state's contentious U.S. Senate race, the debate over that signature piece of legislation continues to loom large.
Republican incumbent Sen. Scott Brown won the state's special election two years ago by vowing to be the "41st" vote against the health care legislation. As he seeks re-election, Brown is again pledging to help repeal the law.
Democratic rival Elizabeth Warren is a staunch defender of the law, pointing to what she says are its successes, including the expansion of insurance to millions of Americans and added benefits that were not included in Massachusetts' 2006 health care law.
The Massachusetts law provided a model for Obama's law.
Brown argues that the 2010 Affordable Care Act includes too many tax hikes and the decision to expand care should be left up to the states. Warren counters that getting rid of the law would again plunge the country into a rancorous debate over health insurance.
For both candidates, the fight over the health care law is critical as they try to appeal to key voting groups during the final two weeks of the campaign.
Brown, who needs to drive up his support among independent voters, is portraying the law as an example of federal intrusion. Brown supported Massachusetts' health care law and says all Americans deserve health care coverage, but he says Obama's law goes too far.
"Health care reform should be left to the individual states as we did here in Massachusetts, and we should not cover our citizens with higher taxes because our economy is going in the wrong direction," Brown said.
Warren, who needs to maintain enthusiasm among Democrats and women while also reaching out to independent voters, says the federal law includes additional benefits for Massachusetts residents that were not part of the state's 2006 health care law.
She said repealing the federal law would hike out-of-pocket costs for seniors with high prescription drug expenses, reinstate lifetime benefit caps and end a requirement allowing children up to age 26 to stay on their parents' coverage.
"Sen. Brown would go back to Washington to have endless fights over health care and he would take away important benefits for people here in Massachusetts," Warren said. "Republicans ... have nothing to put in its place, so presumable they want years more of fighting."
Brown has argued that repealing the federal law would have little impact on Massachusetts.
Among the tax hikes Brown has criticized is a 2.3 percent tax on the sale of medical devices included in the federal law, which he said would put an added burden on the more than 200 medical device manufacturers in Massachusetts.
Warren says she also believes the medical devices tax should be repealed.
A second tax Brown points to is a tax on high-cost health insurance aimed at the most generous plans - a so-called "Cadillac tax" that goes in effect in 2018. Brown argues the tax could also affect insurance policies for unions including those covering firefighters, police and teachers.
A Warren spokeswoman said the tax is not a provision she would have advocated for, but the overall bill will lower health care costs and ease the burden on middle class families.
The Affordable Care Act isn't the only health care issue being debated in the Senate campaign.
Warren has criticized Brown's support for an amendment that would have let employers or health insurers deny coverage for services they say violate their moral or religious beliefs, including birth control. The amendment was defeated.
Warren said the measure could have curbed women's access to health care by permitting "any employer or any insurance company on any vague grounds of moral objection to deny coverage for birth control, for mammograms, for cervical cancer screenings and other preventive services."
Brown said he was trying to protect the religious freedoms of Catholics and others who object to covering birth control.
"She's actually pitting women against their church and their faith," Brown said. "She's not with all women. She's actually trying to divide women in this very important issue."
The two have also wrangled over the future of Medicare.
Brown has criticized Warren, saying she supports "gutting Medicare by three quarters of a trillion dollars." Warren said the $716 billion in cuts - spread out over the next decade - target waste, abuse and subsidies to insurance companies, won't harm Medicare benefits, and would extend the life of the program.
Brown argues the cuts include $14 billion in Medicare reductions to Massachusetts health care providers and nursing homes. In a radio ad, Brown says he opposes any Medicare changes that would affect today's seniors or those nearing retirement and said any "reform plan must be bipartisan."
Warren said Brown's portrayal of the federal health care law's effect on Medicare has been debunked by independent analysts, including the AARP, a lobbying group for seniors. She said Obama's law strengthens guaranteed benefits, while prohibiting cuts to guaranteed Medicare benefits.
The Massachusetts race is already the most expensive in state history and the costliest Senate race in the country this year. Both national parties are keeping a close eye on the contest as they wrestle for control of the Senate.
This program aired on October 21, 2012. The audio for this program is not available.