In spite of the flurry of news last week regarding the future of the nation’s signature healthcare law, the path forward for the Affordable Care Act is not the blitzkrieg President Donald Trump or Republicans envisioned.

On Wednesday, Feb. 15, the Trump Administration proposed regulations intended to “stabilize the individual and small group markets.”  A day later House Speaker Paul Ryan, R-Wis., issued a policy brief and said legislation would be introduced after the House returns from a 10-day recess on Feb. 27. In response, Obamacare advocates are warning that changes will reduce government aid to needy patients and present more obstacles to medical care. Closer to home, on Friday, California State Sen. Ricardo Lara, D-Bell Gardens and Sen. Toni Atkins, D-San Diego introduced a bill that aims create a single-payer system replacing private insurance with a government plan.  Over the noise and rhetoric, the big questions remain: who will pay for the future healthcare system – and what it will ultimately look like?

Instead of quick action, it will be a long, incremental slog on the way to unwinding or reforming the enormously complex healthcare law.  Like trench warfare, it will be characterized by attrition, stalemate and much futility. The debate around national healthcare, characterized by extreme changes in popularity, will also be a policy and public relations roller coaster.

NBC News and the Wall Street Journal, which have been polling views of the health law since 2009, showed in January 2017 that more people viewed the health law as a good idea than as a bad one.  However, this was the first time favorability exceeded contempt toward the ACA in six years of polling.  More hills and valleys are to come.

Creating a functional and sustainable healthcare marketplace has significant implications in California, where the fate of maintaining 1.5 million newly insured through Covered California hinges on how the Federal law is reformed or repealed (as well as the possibility of Senator Lara and Atkins’s Healthy California Act).With that in mind, here are three truths about the Affordable Care Act that will influence the outcome of the law for Californians.

Just as the Trump Administration miscalculated how quickly they could move to repeal the law, supporters, including in California, have miscalculated the prospect of saving it. On its current course, it is all but certain Obamacare will be barely recognizable in one to two years. The degree to which it will change depends on how well either side can share a compelling vision of what revised healthcare coverage could and should be – preserving the right to choose your own health coverage or providing an affordable option to the uninsured.

California’s progressive and Washington D.C.’s conservative establishments will have an adversarial and outsized role in determining the outcome of repeal or reform. Nationally and in California, healthcare organizations negatively affected by reform or repeal have boisterously opposed changing the law. But, Republicans in Washington (who, truth be told, have no consensus) will still manage get a plan together that starts with repeal and ends in replacement. In this era of uncertainty, now would be the opportune time for California interests to proactivity and quickly lay out the conditions for an acceptable reform law. The Healthy California Act, while currently short on details, may be influential in fueling that discussion. Tipping the scale will be the interest that prevails in the long-term public opinion battles – ACA critics showcasing middle-class families with high-deductibles struggling to afford care vs. proponents demonstrating how Obamacare is a fair-deal for all that improves public health.

California’s business community could be the deciding factor in healthcare reform. California’s largest employers and business interest groups have yet to weigh in favor of reform or repeal.  For all of the hub-bub about being resistant to the ACA when it was introduced, California’s small business community in particular may today sing a different tune.  A large number of businesses have enjoyed the benefit of stabilized cost of insuring employees and better worker morale. Supporters of maintaining ACA would be wise to start engaging small business organizations, urging them to back the law or, at a minimum, not opposing it.

When Obamacare was implemented in March 2010, its main purpose was to improve accessibility and lower costs. Flash forward seven years: enrollment numbers are down and costs are up. The future of a national healthcare system in California and nationwide is in question. For or against, the forces that control the fate of our future healthcare system are galvanizing. The extent to which each side can articulate a persuasive public message now will determine what kind of national healthcare approach exist in the U.S. down the road, if such a thing exists at all.

Patrick George works for KP Public Affairs in their Healthcare Practice.