Article updated: 10/20/2013 6:52 AM

The greatest threats to the ultimate success of the new health care law come not from the technical problems that have plagued its rollout, but from a hostile political climate in many individual states and from potentially serious weaknesses in its design.

Those are the conclusions of a cautionary report just published by the Brookings Institution's new Center for Effective Public Management.

The authors are center director Elaine C. Kamarck, who served as a top policy adviser in the Clinton administration, and Sheila P. Burke, who was chief of staff and top health care adviser to former Senate Majority Leader Bob Dole, R-Kan..

"The highly politicized environment in which this law takes effect means that in the short-term people will see what they want to see," Burke and Kamarck wrote.

To an extraordinary degree, they argued, the Affordable Care Act's fate has been put in the hands of individual states and therefore, will be subjected to political forces within those states.

Its launch also coincides with an election year, which means that the agendas of the two parties will come into play. The law that is the signature achievement of Barack Obama's presidency was passed by a Democratic-led Congress without a single Republican vote.

"Going forward, politicians are hoping to use the health care issue to impact the midterm elections of 2014," Burke and Kamarck wrote. "For Republicans, the hope is that the long-standing skepticism about the law will be reinforced as it is implemented and yield a political bonus in the 2014 midterm elections. Democrats obviously hope that a positive start will help reduce barriers to implementing the law and improve their political prospects."

State elected officials have moved in partisan directions as they have exercised their options within the law. Among those choices: whether to expand their Medicaid programs to cover the poor, whether to set up their own health insurance exchanges or rely on the federal one, and how aggressively to promote the new coverage options.

Most Democratic governors have built their own state exchanges, expanded their Medicaid programs, and are devoting intense effort toward making the Affordable Care Act work. Generally, their efforts have been proceeding relatively smoothly thus far.

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Health care law's fate could hinge on political climate in states