The Supreme Court’s 5-4 ruling upholding President Obama’s health-care overhaul exhausted court challenges to the law, but kicked off anew a political fight over Rep. William L. Owens’ own 2010 vote in favor of it and his 2012 re-election campaign.

Asked to reflect on the political ramifications of the court’s affirmation, Mr. Owens redirected the issue to how he believes the law will benefit constituents by improving the quality of and access to care.

“I’ve been having this discussion for three elections,” said Mr. Owens, D-Plattsburgh. “I think I’ve hashed it out completely.”

Mr. Owens voted in favor of the law shortly after he took office, and his 2009 special election was viewed nationally through the prism of the sweeping health-care law, officially dubbed the Patient Protection and Affordable Care Act. More than two years later, Republicans and Democrats alike are trying to gain control of the narrative surrounding the law. Republicans say that Mr. Owens and other Democrats should be voted out, so that Republicans can take power and repeal the law. But Democrats say, not so fast: Repealing the law would do away with many of its popular provisions.

His Republican opponent now and in 2010, Matthew A. Doheny, has made Mr. Owens’ vote for the bill a cornerstone of his campaign. So have Republicans nationally.

“Take Control of Our Healthcare: Don’t Send Owens Back,” read the most recent news release from the National Republican Congressional Campaign.

Democrats, though, sought to highlight the provisions in the bill that Americans support. The bill works by expanding Medicaid eligibility, by creating state-based health-care exchanges to regulate insurance and by requiring every American to have health insurance.

“Matt Doheny wants to let insurance companies kick kids off their parents’ plans, he wants women to be charged more for healthcare just because they’re women and he wants insurance companies to be able to deny coverage to anyone with a pre-existing condition,” Joshua Schwerin, a spokesman for the Democratic Congressional Campaign Committee, said in an email. “Under Matt Doheny’s plan, Medicare would be drastically cut and seniors would be forced to pay more for their prescription drugs.”

Mr. Doheny supports repeal of the health care law.

One nuance in Chief Justice John Roberts’ opinion will also be used as a political cudgel. Mr. Roberts disagreed with the government’s argument that it could require Americans to buy health insurance under the Commerce Clause of the Constitution, which allows the federal government to regulate interstate trade. But Mr. Roberts did say that the federal government could tax people who don’t buy health insurance. The difference was one of interpretation, but Republicans quickly seized upon the opportunity to criticize Democrats for voting for a tax increase.

“The Supreme Court told us that ObamaCare is one of the biggest tax hikes in history and, by extension, Bill Owens’s very first vote in Congress was to raise taxes on the American people,” Mr. Doheny said at a campaign stop in Canton.

The fact-checking site Politifact calls “pants on fire” (a significant misstatement) the claim that the health care law represents the biggest tax hike in history, but it does conclude, as Mr. Doheny states, that the law increased taxes — on tanning beds, on high-end insurance plans, and on medical device manufacturers, for example.

Mr. Owens doesn’t think calling the violation of a mandate to buy health insurance a “penalty” or calling it a “tax” makes much of a difference in real life.

“From my point of view, the issue of whether this is something derived through the tax clause or the Commerce Clause is largely an inside game for lawyers and for the Supreme Court to decide,” Mr. Owens said in a conference call with reporters on Thursday afternoon. “But from my perspective, those of us who have insurance, those of us who pay taxes, all have a penalty imposed on us when our friends and neighbors don’t pay health insurance.”

That’s because people who don’t have health insurance still must be cared for. That helps send up the cost of medical care, and was part of the impetus to put the mandate to buy health insurance in the health-care bill. And many of the bill’s other provisions wouldn’t work without the mandate, Mr. Owens has argued. If someone doesn’t have to buy health insurance, but can’t be denied for having a pre-existing condition, he or she could just buy health insurance right after getting sick. The logic behind the Affordable Care Act, supporters say, is that the influx of the young and healthy onto the rolls of the insured will help pay for those who need care.

Mr. Owens has supported the repeal of several provisions in the bill, including a 2.3 percent excise tax on medical device manufacturers, which hasn’t become law, and the repeal of an onerous Internal Revenue Service requirement on small businesses, which did. Mr. Owens said he’ll be looking at more ways to modify the bill, not replace it — which is possible only because the Supreme Court let it stand in the first place.

A big win for the Owens team?

“I don’t think this is a victory for anyone other than my constituents who are in need of health care coverage,” Mr. Owens said.

Times staff writer Darren Ankrom contributed to this report.

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