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Two years to the day after President Obama signed it into law, the Affordable Care Act remains very much a work in progress.

The White House says its health-care reforms have improved the lives of millions, though the legislation鈥檚 most important provisions have yet to take effect. Detractors 鈥� a category that includes every GOP presidential hopeful 鈥� scorn Mr. Obama鈥檚 health reforms as Treasury-busting infringements on American freedoms.

Yet the most important question dealing with the ACA may be not how it鈥檚 doing, but whether it will survive. Next week the Supreme Court hears oral arguments on the constitutionality of the law鈥檚 lynchpin requirement that individuals carry health insurance.

鈥淲hat鈥檚 at stake basically is whether or not the signature domestic achievement of the Obama administration is sustained,鈥� says Russell Wheeler, a visiting fellow in governance studies at the Brookings Institution, in an on the Affordable Care Act鈥檚 future.

Obama himself did not make a big live appearance promoting the ACA鈥檚 birthday. That could be in deference to the upcoming Supreme Court arguments, or it could be a reflection of the fact that polls show US voters remain split on whether the law鈥檚 passage was a good thing.

White House spokesman Jay Carney said Thursday it is 鈥渁bsurd鈥� to think that Obama is distancing himself from the health law. Carney noted that Obama鈥檚 campaign has produced a video featuring Americans who have benefited from the ACA.

And the White House itself on Friday highlighting what it called the progress produced by the legislation.

Among its assertions: 2.5 million more young adults have health insurance, thanks to an ACA requirement that they continue to be covered on parental policies; 5.1 million Medicare recipients have saved $3.1 billion on prescription drugs because of increased ACA coverage limits; and insurance firms can no longer drop policy-holders who get sick if they made a mistake on their applications.

鈥淎nd thanks to health reform, all Americans will have the security to know that you don鈥檛 have to worry about losing coverage if you鈥檙e laid off or change jobs, and insurance companies are required to cover your preventive care like mammograms and other cancer screenings,鈥� concludes the White House report.

Meanwhile, Republican presidential frontrunner Mitt Romney blasted the Affordable Care Act on Friday.

鈥淭his presidency has been a failure. At the centerpiece of this failure is this piece of legislation, ObamaCare,鈥� said Romney while campaigning in Louisiana.

Of course, Romney has his own health-care problem, in that while governor of Massachusetts he signed into law a health bill often credited with serving as the model for Obama鈥檚 national legislation.

In for USA Today this week, Romney outlined his own plan for national health reform, saying that among other things he would offer a tax benefit to individuals to buy health insurance on their own.

Romney added he would turn over responsibility for helping the poor, uninsured, and chronically ill to state capitals, instead of Washington.

鈥淚 favor giving each of the 50 states the resources and the responsibility to craft the health-care solutions that suit their citizens best,鈥� wrote Romney.

Many of the most significant ACA provisions have yet to take effect, notes Kaiser Health News in a of what the law has delivered so far.

State-based exchanges, a kind of marketplace for individual insurance, aren鈥檛 supposed to be up and running until 2014, for instance. That鈥檚 when the US will start subsidizing the purchase of such policies for lower-income Americans.

Some parts of the bill that have already taken effect have exceeded expectations, according to Kaiser. The number of young adults whose coverage has continued on parental polices is almost twice the number predicted at the law鈥檚 passage, for instance.

Other provisions have underperformed. The White House estimated that 4 million small businesses by now would be receiving tax credits for their contributions to employee health plans. As of last November only 309,000 businesses had qualified for these credits.

Will all this be a moot point? It鈥檚 possible the ACA health care reforms will collapse if the Supreme Court strikes down the individual mandate at the heart of the bill. The requirement that individuals carry insurance makes economically possible such popular parts of the ACA as the provision that insurers cover people with pre-existing conditions.

Such a move by the Supreme Court would also mark a turning point in American constitutional law, according to Russell Wheeler of Brookings.

For decades many constitutional scholars have assumed that Congress has extensive powers to regulate US economic activity under the Constitution鈥檚 Commerce Clause. But if the justices reject the individual mandate, they鈥檇 be calling into question that interpretation of the law.

鈥淚f the court strikes down the individual mandate our constitutional law will take a 180 degree turn,鈥� says Wheeler.