In between an audience with Pope Francis, a meeting with Italian leaders and a tour of the Colosseum, President Barack Obama interrupted his day-long visit to Rome on Thursday to phone home about a much more important issue – healthcare.
After months of political pain over the signature social reform of his presidency, Mr Obama was desperate to promote some rare good news – more than six million Americans had signed up to buy health insurance under his policy.
In the opening month after the policy’s disastrous launch in October, only 106,000 people signed up. In the past 10 days, about a million logged on to the federal and state websites to register to buy plans.
An “amazing comeback story”, tweeted Dan Pfeiffer, Mr Obama’s senior political adviser, one of many White House staff who said such numbers were dismissed as “impossible” a few months ago.
With the deadline for signing up on Monday for the first year, the health policy is now on track to beat the revised targets set after the initial rollout, when the website was besieged by technical problems.
But for Mr Obama and a Democratic party struggling to hold on to its Senate majority in elections in November, the surge in enrolments may be too late.
The headline number alone, as well, offers no benchmark for judging whether the policy designed to help, and force, millions of young and mainly low-income uninsured Americans to buy coverage is working.
The highly politicised patchwork quilt of states that have, and have not, signed on to the policy and its various incentives, makes a national picture impossible to discern through the partisan fog of war.
“What matters now is not the overall number but what is happening state by state – in reality we have 51 different market places – and this early, it is hard to draw any definitive conclusion,” said Jennifer Tolbert, of the Kaiser Family Foundation.
As the most ambitious social reform in the US in decades, taking on a vast, powerful industry with complex, interwoven public and private bureaucracies worth nearly 20 per cent of the US economy, Obamacare, as Republicans mock it, was always going to be difficult.
In the short term, the reform’s launch seems to have permanently scarred Mr Obama’s presidency – his approval ratings headed south last October and have not recovered.
After a resounding victory in the 2012 presidential election, Mr Obama is now being shunned by Democratic senators struggling to hold their seats in the congressional poll, other than as a fundraiser who can provide money.
“He is kind of out of the game – when you have numbers like his, no one wants you to come into their states,” said Bill McInturff, a Republican pollster who conducts a widely watched survey for NBC and the Wall Street Journal with a Democratic firm.
The much-touted headline figure does not display how many who have signed up are new enrollees, or people who had their earlier plans cancelled under the law’s rules governing insurance.
“Cancelling millions of policies, then bragging when they sign up for another one is a little odd, don’t you think?” said a spokesman for Mitch McConnell, the Republican Senate minority leader.
Mr Obama’s credibility suffered a fatal blow on this point, as he had promised without equivocation on the campaign trail that people could keep their health insurance plans if they wanted to.
Nor does the six million number break down the age of the enrollees – too few young people, or too many unhealthy people, signing up could sharply lift premiums across the board in the future.
“What really matters to insurers is the health status of insurers, not their age,” said Ms Tolbert.
The administration will at least be cheered that its concerted grassroots campaign over the past month, ranging from comedy videos featuring Mr Obama and tens of thousands of volunteers working to sign people up, has borne some fruit.
But the real test of Mr Obama’s law – whether it can hold down the runaway health costs which are the biggest driver of America’s long-term budget problems – will not be known for years.
The early signs are good, with the index of health inflation falling in January, a trend in line with slower rises in recent years, in part because of the law’s restrictions on spending on aged care.
But that may matter little in November’s election. “Mr Obama is not going to be a positive factor for the Democrats,” said Mr McInturff.