The Affordable Care Act, aka Obamacare, has been making a modest comeback since the Supreme Court ruled in June that it is indeed constitutional. It’s now a standard part of President Obama’s stump speech, right there with saving the auto industry and killing Osama bin Laden. And last week, senior adviser David Axelrod sent an unusually personal fundraising appeal about his daughter’s “intractable epilepsy” when she was seven months old -- a struggle he said “nearly bankrupted our family and burdened her with a pre-existing condition that threatened her future coverage.”
But the true measure of the controversial health law’s standing, with Obama and the public, will be how it is handled at the Democratic National Convention this week in Charlotte. The convention presents a high-profile opportunity for Obama and his party to do what they haven’t done before: Sell this law.
The Affordable Care Act won’t be ignored, as Mitt Romney’s similar Massachusetts law was at the Republican convention. The question is whether it will be glossed over or promoted in a prominent way. The answer seems to be somewhere in the middle. Obama campaign spokesman Adam Fetcher said the health law will be woven into a larger economic narrative of the Obama presidency. Obama and other speakers will contrast the historic accomplishments of the law with Romney’s vow to repeal it, Fetcher said, and delegates will hear from “real people” whose lives it has improved.
Several party strategists said that, as one put it, there’s tremendous energy behind going on offense. Pollster Stan Greenberg said he’d “absolutely” push Democrats to talk about the law. Another pollster, Geoffrey Garin, called the convention “the right forum” to let voters know about the act’s insurance reforms for consumers and tax breaks for small businesses, and to “set the record straight” on how the law treats Medicare.
“Romney's position on repeal exposes him to legitimate attacks on a range of issues – pre-existing conditions, insurance equity for women, excessive rates charged by health insurance companies -- and I expect Democrats to play offense on these,” Garin said in an email.
One of the highlights of the GOP convention was when parents talked about how Romney had helped and comforted their sick children, one of them a teen-ager on his deathbed. Just as those speeches humanized Romney, Democrats may be able to put a human face on the Affordable Care Act through their “real people” -- say, a parent whose sick child was able to get coverage because of the law; a 22-year-old who without it would have been kicked off the family plan after graduating from college, or a 70-year-old whose prescriptions under Medicare are more affordable now.
“Obamacare” was a hot topic at the Republican convention, no more vividly than in vice presidential nominee Paul Ryan’s speech. He called the process of enacting the 2010 law “a long, divisive, all-or-nothing attempt to put the federal government in charge of health care” and described it as nothing less than anti-American. “Obamacare comes to more than two thousand pages of rules, mandates, taxes, fees, and fines that have no place in a free country,” he said.
Ryan also contended that “the biggest, coldest power play of all in Obamacare came at the expense of the elderly… Seven hundred and sixteen billion dollars, funneled out of Medicare by President Obama.”
The savings over 10 years affect reimbursement rates to doctors and hospitals, not benefits to people on Medicare, and Ryan has written budgets that cut back Medicare growth by a similar amount. Private insurance companies, meanwhile, are expected to experience a boon when insurance marketplaces for consumers go online in 2014. Still, the general Republican line of attack resonates with conservatives and moderates who are concerned about government regulation and spending, and Romney's vow to repeal the law is not going away.
The latest polling from the Kaiser Family Foundation illuminates both the difficulties of selling the Affordable Care Act, and the potential payoff if Democrats decide to try. Only 38 percent of the 1,208 adults in the Aug. 7-12 poll said they had a very or somewhat favorable view of the law, compared with 43 percent unfavorable. Another 19 percent said they didn’t know or refused to answer.
A follow-up question suggests some of the negative views may be held by people who wish the law did more: 26 percent said they wanted to expand it. Another 23 percent said it should be left the way it is. As for the GOP argument, 20 percent said the law should be repealed and replaced with a Republican alternative; another 20 percent said it should simply be repealed.
The poll showed much of the country either doesn’t know what’s in the law or has the wrong idea about what it does. Many people blamed it for rising costs, though costs have been rising for decades. Yet Obama still holds an advantage on health. Asked who they trust to make the right decisions about the future of the 2010 law, 53 percent said Obama and 40 percent said Romney.
The fundraising email from Axelrod arrived in in-boxes just as Ryan was stepping onstage in Tampa last week to accept the vice presidential nomination and blast the health law, and a few hours after Obama had offered a full-throated defense of what he himself is now calling Obamacare.
“We could go back to a health care system that lets insurance companies decide who and when and what to cover. But I think we’ve got to move forward with Obamacare,” Obama said in Charlottesville, Va., to a crowd of students cheering or booing his every line. “It’s already cutting costs. It’s covering more people. It’s saving lives.” He finished an extended riff on the law by accusing Romney of “running on the ‘Romney Doesn’t Care’ platform.”
Since then Obama has been less expansive, but health reform is still part of his highlights reel. That in itself is a major change from three years ago, when the reform push helped ignite shouting matches at town halls, and two years ago, when the new law helped fuel a revolt against Democrats at the polls.