Three years after it split Massachusetts voters in the 2010 special U.S. Senate election, the debate over President Barack Obama's health care law has lost little of its political punch.
Of the five candidates vying to fill the seat left vacant by John Kerry's resignation, just one has offered a full-throated defense of the law. Democratic U.S. Rep. Edward Markey has described his vote for the Affordable Care Act as "the proudest vote of my career."
Markey's primary opponent, fellow Democratic U.S. Rep. Stephen Lynch, voted against the bill and continues to point to what he says are serious flaws. But Lynch has stopped short of calling for its repeal.
The three Republicans in the race - former U.S. Attorney Michael Sullivan, Norfolk state Rep. Daniel Winslow and Cohasset businessman Gabriel Gomez - are all strong critics of the law.
Sullivan and Gomez say they support repealing the law; Winslow says he'd push to give states a chance to opt out of it.
The jousting is more vigorous on the Democratic side.
Lynch has described the 2010 law as a giveaway to the insurance industry. He said the decision to abandon a proposed "public option" that would have created government insurance plans that could have competed with private plans ended up benefiting insurance companies even as the law requires tens of millions of Americans to obtain health insurance.
"What the insurance companies wanted, they wanted 31 million new customers. We gave them everything they wanted," Lynch said in a recent debate. "It was like a hostage situation where we not only paid the ransom, but we let the insurance companies keep the hostages."
Lynch also said the law includes so many new taxes that employers "are running away from their health care obligations."
Markey said that when Lynch had a chance to cast a vote for the broadest expansion of health care in generations - a decades-long Democratic quest - he sided with Republicans.
"(The law) ensured that if a person has a pre-existing condition that they cannot be denied health insurance, that every child in America would have health care, that if a person in a family became ill that family did not become bankrupt," Markey said. "Steve, when that vote came up you were wrong when you were needed most."
Of the three Republicans, Sullivan is perhaps the law's harshest critic.
Sullivan said Obama failed to understand that Americans value top-notch care and easy access, while they fear rising costs.
"The one problem we didn't like, Obamacare didn't fix. Costs are going up considerably," Sullivan said. "The two things we like best about health care - quality of care and access - are going to continue to decline based on the way that they provide reimbursements to (health care) providers."
He also said the law isn't needed because "people that are poor and uninsured have access to the quality of care and they have access to good doctors."
Gomez said he would vote to repeal the law, but he agreed with what he called its "overall theme" of universal and affordable high quality care.
"I don't think he went about it the right way at the federal level," Gomez said of Obama. "I think it should have been out of the state level, just like we did here in Massachusetts when Gov. Romney was governor."
Gomez, who was referring to Massachusetts' landmark 2006 health care law, also conceded that repealing the federal law is unlikely.
Winslow said the federal law was bad for Massachusetts, imposed unnecessary taxes and is costing jobs, but he didn't say if he would vote to repeal it.
Instead, Winslow said he supports an initiative he dubbed "Excel and Exempt."
"If a state has met the level of excellence that the federal government has specified, the state is automatically exempt from Obamacare and automatically exempt from all of the taxes under Obamacare," he said.
Even Markey concedes the law has some elements he would change.
Markey said this week he would have sided with a majority of senators in voting to strip away a key element of the law - a 2.3 percent sales tax on medical devices such as catheters and pacemakers. Medical device companies employ nearly 24,000 people in Massachusetts
The Senate voted 79-20 earlier this month to repeal the tax. Among those voting to eliminate the tax were Sens. Elizabeth Warren and William "Mo" Cowan, both Massachusetts Democrats.
Markey said he could support changes to the law "as long as those repeals do not in any way harm poor people or (the) middle class."
But Lynch said Markey is trying to have it both ways.
"More and more people who voted for (the law) are now picking all these bad sections out of the bill and saying we didn't like those really, but we voted for them," Lynch said.