MAUMEE, Ohio â€" A week after the Supreme Court upheld most of President Obama's signature domestic policy achievement, the politics of healthcare held center stage in the presidential campaign, shoving aside the economic debate that has dominated most of the last several months.
In a notable shift of tactics after months of talking only minimally about healthcare in public, Obama went on the offensive Thursday and emphasized the law during a campaign bus trip through the crucial swing state of Ohio.
As he did so, his Republican challenger, former Massachusetts Gov. Mitt Romney, was on the defensive, under attack from leading conservatives for purported failures in handling the issue. The criticism reflected long-standing anxiety among conservatives that Romney's history on healthcare would make him a flawed carrier of the party's message.
Before a cheering crowd of several hundred at a rally in northwestern Ohio, Obama declared that the healthcare law was alive and well and highlighted elements that have proved popular with the public â€" even as the overall law has not.
"We will not go back to the days when insurance companies could discriminate against people just because they were sick," he said. "We're not going to tell 6 million young people who are now on their parents' health insurance plans that suddenly they don't have health insurance. We're not going to allow Medicare to be turned into a voucher system.
"Nobody should go bankrupt because they get sick. I'll work with anybody who wants to work with me to continue to improve our healthcare system and our healthcare laws. But the law I passed is here to stay."
As he spoke, campaign aides distributed literature listing the benefits of the law, defiantly stealing the label that Republicans have used to attack it. "Because of Obamacare," the list began.
As Obama waved the healthcare banner, Romney, vacationing in New Hampshire, seemed tongue-tied on the issue.
As governor, Romney's biggest achievement was a law that resembled Obama's in many ways, particularly in the requirement that people who could afford to do so either buy insurance or pay a fine. During the primary campaign, his rivals predicted that as the nominee, he would have trouble convincing voters that his requirement was good and Obama's virtually identical requirement was bad.
Since the Supreme Court's decision, Romney's campaign has stumbled over whether to call that requirement a "tax," as Chief JusticeJohn G. Roberts Jr.did in his opinion for the court, or a "penalty," as Romney had previously labeled it.
Republicans in Washington had seized on the tax language after the ruling, figuring that the one victory they could snatch from the court defeat was to accuse Obama of hav ing sponsored a tax increase.
That created a potential problem for Romney because, logically, it would mean that he too, as governor, had imposed a tax increase.
On Monday, Romney's chief spokesman, Eric Fehrnstrom, said in an MSNBC interview that the requirement in the Obama law was a penalty, not a tax. Then on Wednesday, Romney went the other direction, saying in an interview with CBS that the requirement was a tax.
On Thursday, two of the conservative movement's leading platforms â€" the editorial page of the Wall Street Journal and the Weekly Standard magazine â€" reacted by publicly upbraiding the candidate and his aides.
"The campaign looks confused in addition to being politically dumb," the Journal said, and it accused Romney's "insular staff" of "slowly squandering an historic opportunity."
In the Standard, Editor William Kristol, never a Romney fan, compared the former governor to two other Massachusetts politicians who unsuccessfully ran for president: Sen. John F. Kerry and former Gov. Michael Dukakis, both Democrats.
"So," Kristol wrote, "speaking of losing candidates from Massachusetts: Is it too much to ask Mitt Romney to get off autopilot and actually think about the race he's running?"
In a statement, Romney campaign spokeswoman Amanda Henneberg said that "Obamacare has been and will continue to be a central issue in this campaign. It presents voters with a clear line that divides the two candidates. Gov. Romney is going to repeal Obamacare and President Obama is going to keep it."
It's unlikely that many â€" if any â€" voters will be influenced by a debate as arcane as tax versus penalty. But Obama aides hope that Romney's switch of position will highlight a bigger issue â€" underscoring what they see as his flips on other matters. Obama's backers have pressed that message for months, as did Romney's opponents during the Republican primaries.
The campaign also wants to hig hlight Romney's refusal thus far to say whether â€" if he is successful in pressing the repeal of Obama's policy â€" he would restore its most popular provisions, such as protection for people with preexisting medical conditions.
Even if he feels emboldened, Obama still has to worry about the widespread distrust of his healthcare law.
In the crowd in Maumee, for example, was a union bricklayer who showed up to cheer the candidate he hoped would be elected in November â€" despite his worries about the healthcare law.
"I'm excited about what he could do in a second term," said Eric Herbster, 35, who is working on the Maumee city tree crew to make ends meet until the bricklaying business picks up again. "He'll get rid of outsourcing. He's talking about keeping jobs in this country."
But the mandate that everyone buy insurance?
"I can't afford that," Herbster said. "Obamacare â€" that's the only thing I'm on the fence about."
christi.parso ns@latimes.com
mitchell.landsberg@latimes.com
Parsons reported from Maumee and Landsberg from Gilford, N.H.
David Lauter in the Washington bureau contributed to this report.
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