President Obama, marking major provisions of the new healthcare law that go into effect Thursday, visited with Americans who stand to benefit immediately as he stepped up efforts to repulse Republican attacks on his signature domestic initiative.
"Obviously, the economy has been uppermost on our minds," Obama told a small gathering Wednesday at the home of a Virginia man who suffers from hemophilia and hit a lifetime limit in his private health insurance coverage.
But the president said he felt he had to do more than end the economic contraction.
"Healthcare was one of those issues that we could no longer ignore. … We said we have to take this on," he said, citing stories of people going bankrupt because of their medical bills. "We are now actually able to provide some help to the American people."
Though many of the most sweeping benefits of the law do not go into effect for years, millions of consumers stand to gain substantial new protections starting this fall. (The benefits apply to plan years starting Thursday, although many Americans may not see the changes until January when their health plans renew.)
Insurance companies, for example, will be prohibited from canceling policies when customers get sick or from denying coverage to sick children. Some insurers have said they will stop selling policies exclusively for children rather than comply.
The law will allow parents to keep their adult children up to age 26 on their family plans, and will bar insurers from placing lifetime caps on how much they will pay when their customers get ill.
And many consumers will get new rights to appeal claims that are denied by insurers and win new access to preventive care without being asked for co-pays.
"There are many meaningful reforms here that, while not perfect, will help millions of consumers get a fairer shake when they buy and use health insurance," said Jim Guest, president and chief executive of Consumers Union, the nonprofit publisher of Consumer Reports.
Many more changes, including guarantees that all Americans can get coverage and millions of dollars of subsidies to help them pay their premiums, will go into effect in 2014.
Other changes have already started, such as tax breaks for small businesses and the gradual phase-out of the coverage gap in the Medicare Part D drug benefit.
But public misunderstanding about the new law remains high, fueled in part by Republican attacks.
A recent survey by the nonprofit Kaiser Family Foundation found that nearly half of the country's seniors believed erroneously that the law created a new government panel to make decisions about end-of-life care for people on Medicare.
"The messaging wars and the rhetoric are really muddying the picture," said Mollyann Brodie, who oversees the Kaiser poll.
Republican lawmakers, energized by their brightening political prospects, are staking out plans to try to roll back parts of the law should they take control of Congress next year.
On Wednesday, Wyoming Sen. Michael B. Enzi, the senior Republican on the Senate health committee, called for senators to back his resolution criticizing a provision of the law designed to discourage businesses from scaling back health benefits.
The provision would place new requirements on health plans provided by employers, such as providing free preventive care, if employers substantially raise co-pays, deductibles or other employee contributions.
"The administration's grandfather rule is a job-killing, wage-cutting game-changer for small business," Enzi said. "This is not the kind of reform the people wanted."
Republican leaders are expected to outline more detailed plans Thursday for repealing other parts of the law when they unveil their much-anticipated governing agenda.
Close to half the country continues to oppose the new law, despite efforts by the Obama administration and consumer and patient advocates such as the American Heart Assn., the American Cancer Society's Cancer Action Network and U.S. Public Interest Research Group.
In part, the polls reflect the high degree of political polarization and the near-even split between Democrats and Republicans in the country as a whole, with most Republican respondents following party leaders in criticizing the healthcare overhaul and Democrats adhering to their party's support for it.
The White House on Wednesday again tried to sell the overhaul by surrounding the president with Americans who are benefiting, including several small-business owners who plan to use the tax credits and seniors who have received $250 rebate checks to help them with their prescription drug bills.
Obama also met with state insurance commissioners whom the administration is counting on to protect consumers from excessive rate hikes by insurance companies.
And the White House unveiled a new health website that highlights stories of the law's effects from around the country.
"These things are designed not to have government more involved in healthcare," Obama said. "They're designed to make sure that you have basic protections in your interactions with your insurance company, that you're getting what you paid for, that you have some basic measures of protection."