Soft Sell

Obama’s health care reform law turns two years old this week. But you won’t know that from watching the president.

Accompanied by health care professionals, President Barack Obama speaks about health care, Wednesday, March 3, 2010, in the East Room of the White House in Washington. (AP Photo/Alex Brandon)
National Journal
March 22, 2012, noon

This week marks the second an­niversary of the en­act­ment of Pres­id­ent Obama’s health care law, but don’t look for the pres­id­ent to mark the oc­ca­sion at an elab­or­ate event — a seem­ingly odd omis­sion, con­sid­er­ing that the Su­preme Court will in days hear ar­gu­ments from those hop­ing to wipe his sig­na­ture do­mest­ic-policy achieve­ment off the books.

But it’s part of a theme. When it comes to de­fend­ing the law or try­ing to goose its pop­ular­ity, the White House is in­ten­tion­ally keep­ing the pres­id­ent off the stage, leav­ing the selling of its be­ne­fits to prox­ies such as Health and Hu­man Ser­vices Sec­ret­ary Kath­leen Se­beli­us, health care re­form groups, and Obama’s reelec­tion cam­paign.

So far, the evid­ence doesn’t in­dic­ate that the strategy is work­ing. Al­though polls con­tin­ue to show that voters like some as­pects of the law — such as the pro­vi­sion that bars dis­crim­in­a­tion based on preex­ist­ing med­ic­al con­di­tions — little broad-based sup­port ex­ists for the en­tire pack­age, es­pe­cially for its re­quire­ment that all Amer­ic­ans pur­chase health in­sur­ance.

Thus, while Obama jet­ted across the coun­try this week tout­ing his en­ergy agenda, Se­beli­us de­fen­ded the law in places such as Hou­s­ton and Miami. Al­most since the law was passed, the pres­id­ent has shown little in­terest in mix­ing it up with Re­pub­lic­ans over the meas­ure or, for that mat­ter, try­ing to win over doubters.

In this year’s State of the Uni­on ad­dress, Obama de­voted one sen­tence to the health care law, al­though he didn’t hail its pas­sage or even men­tion it by name. Con­sequently, it barely showed up in sub­sequent speeches and van­ished en­tirely amid fevered West Wing anxi­ety over the polit­ic­al im­plic­a­tions of high­er gas prices.

But White House Com­mu­nic­a­tions Dir­ect­or Dan Pfeif­fer, on whose shoulders the task of selling the law has fallen, denied that Obama is duck­ing the health care fight or giv­ing it short shrift. “Since passing it, we have been very care­ful in our dis­cus­sions of the law to de­pol­it­i­cize the de­bate as much as pos­sible,” Pfeif­fer said. “That lim­its our biggest re­sources, the pres­id­ent and the vice pres­id­ent, who are in­her­ently polit­ic­al.”

Pfeif­fer de­fends the low-wattage ad­vocacy as a de­cision to el­ev­ate gov­ern­ment ob­lig­a­tion over cam­paign­ing. Obama’s em­phas­is, he said, re­mains on those who stand to be­ne­fit from the law now, while the politi­cians and law­yers fight over its fu­ture in a sep­ar­ate sphere. He said he’s proud that no stor­ies have sur­faced about con­fused con­sumers un­cer­tain what the law does or how it works when they try to ob­tain new be­ne­fits. “It has to work well,” Pfeif­fer said. “It has to be dur­able.”

He and oth­er Obama aides know that the law has crit­ics and that even close friends of the White House aren’t en­thu­si­ast­ic about the sales cam­paign. “It has been a com­mu­nic­a­tions chal­lenge, and we’re go­ing to plow for­ward with it,” seni­or ad­viser Dav­id Axel­rod said on MS­N­BC.

Neera Tanden, pres­id­ent of the Cen­ter for Amer­ic­an Pro­gress, a cen­ter-left think tank, called the Su­preme Court ar­gu­ments an op­por­tun­ity for the White House to re­frame the de­bate. Tanden, formerly a seni­or health care ad­viser to Se­beli­us, told Na­tion­al Journ­al that the “weird at­mo­sphere” around the law is due in part to a soft sell from Obama, pub­lic con­fu­sion about the law, and voters’ fo­cus on the eco­nomy. “The chal­lenge is, talk­ing about health care is a dis­trac­tion right now to the jobs is­sue,” Tanden said, “and politi­cians op­er­ate in the mar­ket­place.”

But Howard Dean, a former pres­id­en­tial can­did­ate, de­fen­ded the ad­min­is­tra­tion. White House of­fi­cials are “do­ing the best they can with a very com­plic­ated law,” he said. “The only ad­vice I have is to look at the parts of it that poll really well and talk about those without men­tion­ing the bill it­self.”

In­deed, HHS has been try­ing to broad­cast the law’s achieve­ments on a gran­u­lar level. In the past few days, the de­part­ment has re­leased a re­port show­ing that 45 mil­lion wo­men have re­ceived free pre­vent­ive ser­vices such as mam­mo­grams un­der the health re­form law; stat­ist­ics in­dic­at­ing that drug dis­counts have saved 5.1 mil­lion seni­ors an es­tim­ated $3.2 bil­lion; and data prov­ing that nearly 50,000 people with preex­ist­ing health con­di­tions got cov­er­age.

Obama’s reelec­tion cam­paign this week sent out e-mails cham­pi­on­ing the law, but they likely went only to those who are in­clined to view it fa­vor­ably. Com­pare and con­trast that with the GOP can­did­ates’ cas­tig­a­tion of the law as a gov­ern­ment takeover of health care — and the mes­saging chal­lenge be­comes starkly clear.

Polls show that the White House, at least right now, has lost the per­cep­tion war in the minds of the middle-class voters whom Obama will need in the gen­er­al elec­tion. Simply put: Des­pite the White House’s best ef­forts to ar­gue that the health care law will con­trol costs and re­duce the de­fi­cit, many voters view it as an en­ti­tle­ment that won’t be­ne­fit them. That’s par­tic­u­larly true of whites. Two years ago, when Obama signed the law, 52 per­cent of white voters said that it would ac­tu­ally make their health care worse, ac­cord­ing to Gal­lup.

And those sen­ti­ments re­main. In a re­cent Kais­er Fam­ily Found­a­tion sur­vey, two-thirds of Amer­ic­ans said they don’t ex­pect the law to af­fect their lives in a pos­it­ive way, and they be­lieve that, in the end, it will largely be­ne­fit lower-in­come Amer­ic­ans and the un­in­sured. Even more troub­ling for the ad­min­is­tra­tion, six in 10 said they don’t have enough in­form­a­tion to un­der­stand how the law will af­fect them per­son­ally.

Pfeif­fer con­tends that the pres­id­ent can’t do much about those per­cep­tions between now and Elec­tion Day. “We don’t have any il­lu­sions we are go­ing to fun­da­ment­ally shift pub­lic opin­ion on this in the short term,” he said.  

Maggie Fox contributed to this article.
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