There’s a seeming paradox in the way Americans view the healthcare law that President Obama and the Democrats passed two years ago this month.
Most people tell pollsters they like the parts of the law that have gone into effect: health insurance for people with preexisting conditions, a clause that allows children to stay on their parents’ health plans until the age of 26 and discounts for prescription drugs on Medicare. And, as time goes by, Americans seem less worried that the law will have a negative effect on their own medical care; in an AP-GfK poll released last week, most people said they expect their healthcare will stay pretty much the same — a big change from two years ago, when many expected dire consequences.
But the law itself isn’t any more popular than the day it passed. In that same poll, only 35% of respondents said they support the law; 47% said they oppose it. A USA Today/Gallup poll last month found the public closely divided on whether the law should be scrapped, with 47% in favor of repeal and 44% opposed.
Those are good numbers for Republicans. With persistence and skill, they have succeeded in convincing a big chunk of the public that the law amounts to a “government takeover” of healthcare and that it will send healthcare costs through the roof.
For Obama, the numbers are at the least a disappointment, and they could make for serious trouble in November.
In the 2010 congressional elections, the healthcare law was a loser for many Democrats and a big motivational device for tea party Republicans. A team of political scientists including Brendan Nyhan of Dartmouth College recently estimated that the issue may have cost the Democrats as many as 25 House seats.
Obama is hoping that the passage of time — and the implementation of those early, voter-friendly provisions — will make the law less toxic this time. For two years, the administration has waged a quiet campaign to promote the law, pointing out its modest successes while mostly avoiding the larger questions.
But it’s a debate Obama can’t duck forever.
On March 26, the Supreme Court is scheduled to begin hearing arguments over the law’s constitutionality, which will bring the issue back to center stage.
And the presidential campaign is certain to keep it there. Every Republican hopeful, including Mitt Romney, has promised to seek the law’s repeal, which makes healthcare one of the clearest lines dividing the Republican and Democratic candidates.
Obama has already been rehearsing his approach. When he’s speaking at Democratic fundraisers, he defends the law, but before more general audiences he tends to focus on the perils of repeal.
“They [the Republicans] want to go back to the days when insurance companies could deny your coverage or jack up your rates whenever and however they pleased,” he told the United Auto Workers last month. There’s one other tactic we can expect Obama to try: Changing the subject to healthcare issues where the Democrats have an advantage. As Harvard’s Robert Blendon has pointed out, there will be two healthcare debates this fall — one over Obama’s insurance law, the other over the Republicans’ Medicare plan.
“It’s in the Republicans’ interest to talk about repealing the healthcare law, but it’s in the Democrats’ interest to talk about Medicare,” Blendon told me.
Why? Because Romney and the other Republican candidates have also endorsed the proposal of Rep. Paul Ryan (R-Wis.) to transform Medicare into a voucher system, an idea that is wildly unpopular among older voters.
“Public opinion on the Obama healthcare law has been remarkably stable,” Blendon said. Republicans hate it, most Democrats like it, and hardly anyone is left in the middle. “You can’t move anybody from one column to another on that issue.”
Medicare may be a different story. “Senior citizens are always worried about the future of Medicare,” he said. “You can move voters over 55 based on those concerns.”
Obama has to hope that’s true, in which case healthcare reform and Medicare may end in a draw, with one helping Republicans and the other helping Democrats.
But it must be a bitter irony for the president that his greatest legislative achievement, a promise kept from his 2008 campaign, has become an albatross.