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This is a pivotal week for health care in America. March 31 is the deadline for almost everyone to have health insurance. After Monday, anyone without coverage, or one of the few narrowly prescribed excuses, will incur a fine.

Pardon us; they will incur a tax penalty. So ruled conservative Chief Justice John Roberts as the U.S. Supreme Court upheld the constitutionality of the individual mandate.

Whatever you call it, the price of forgoing insurance this year is at least $95, and by 2016 it will be at least $2,085.

It's been a rough road getting here. The insurance exchanges that are supposed to provide consumers with coverage options have been plagued with difficulties.

Federal exchanges in states that chose not to set up their own had all sorts of problems at launch. Most of the problems have been fixed, though, and now the exchanges have enrolled millions of Americans and counting.

The states that chose to operate their own exchanges have had mixed results. Our neighbors to the north still have a broken one. Last week, Oregon's governor responded to a scathing report that found mistakes across the board. Few Oregonians have managed to sign up for insurance through Cover Oregon, and only a handful accomplished it online.

Meanwhile, California has shown the nation what success looks like. Covered California had some early hiccups and struggles to reach Latinos and African Americans, but more than 1 million people now have insurance through it. Another 1.5 million Californians have enrolled in or been deemed eligible for expanded Medicaid.

The public recognizes the slow but steady progress taking place on implementing Obamacare. A Bloomberg poll this month found that two-thirds of Americans support the health care law outright or favor only small changes. That's a dramatic turnaround since December when 60 percent disapproved of the law.

Republicans have not yet adapted to the changing political winds. They continue their rhetoric of negativity and attack. By all accounts, they plan to make the health care law a key talking point on the campaign trail leading up to November's midterm congressional elections.

Their mantra has been "repeal and replace." Until recently they only tried to deliver on the repeal with dozens of pointless votes in the Republican-controlled House of Representatives. Now they may finally have something for the replacement. Party leaders recently began shopping around an alternative health care plan.

They aren't making too big a deal about it yet because it will likely land like a brick.

The best alternative Republicans can agree on features tired talking points rejected years ago by the public. Old conservative standards such as high-risk insurance pools and changing medical malpractice rules figure prominently in their proposal. Lost would be popular provisions of Obamacare such as preventing insurance companies from discriminating based on pre-existing conditions and the right of young adults to remain on their parents' insurance until age 26.

The Affordable Care Act improves with each passing day. If it remains on this trajectory, it will serve Americans well for generations. No amount of Republican griping will change that.

Californians who still need to sign up for insurance by Monday have several options:

; Enroll through an enrollment counselor at a local community health center.

; Enroll through an insurance agent listed on the Covered California website.