Govs. Jay Nixon, Jack Markell and Deval Patrick have all reached out to the White House. | AP Photos Dem govs: Obama needs to sell ACA

With the battle over Obamacare moving from Washington to the states and a deluge of ads battering the law on TV, Democratic governors delivered a message to President Barack Obama over the weekend: We need help.

Four years out from passage of the Affordable Care Act, it’s state executives in Obama’s party who may be bearing the heaviest load when it comes to making the law work and selling it to voters. They’ve grappled with their own glitch-ridden enrollment sites and fought their own legislatures over Medicaid expansion.


Now, many of them are running for reelection with the ACA hanging over their heads — and only a limited effort from national Democrats and their president to reverse the consistently negative public opinion of the law.

Asked if the White House had done enough to win over the public on the ACA, Massachusetts Gov. Deval Patrick replied: “The short answer is no.”

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Patrick said he didn’t mean that as a “critique” of the president, but he’s not the only governor who would like to see the White House do more.

Missouri Gov. Jay Nixon told Obama at a closed-door meeting of Democratic governors Friday that the president should do more to play up health care innovations unfolding at the state level. Delaware Gov. Jack Markell said he had counseled senior White House officials to highlight efforts to control health care costs, rather than simply telling now-familiar stories about patients with pre-existing conditions who now have access to health insurance.

As for Patrick, he said he was only noting that there hasn’t been a sustained effort to promote the ACA of the sort Massachusetts health care reformers assembled during the state’s 2006 overhaul.

“We had this coalition of business and labor, policymakers, the medical industry, patient advocates and so on, who helped invent health care reform and then stuck together to refine it and improve it,” recalled Patrick, who is leaving office next year after two terms. “It’s not a critique; it’s an observation that not only did we sell it, but we had allies in selling it. I think the president hasn’t had those advantages.”

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Democrats across the party — not just governors — have raised a hue and cry in recent weeks as conservative outside groups, led by the heavy-spending behemoth Americans for Prosperity, have burned tens of millions of dollars on ACA-bashing ads early in the midterm election season. There is no comparably funded effort on the Democratic side, and a half-dozen senior party strategists said that none is currently anticipated.

Insurers, desperately eager to convince people to sign up for health care policies, have poured millions into an ad campaign of their own, but there’s little indication those ads have served as a political counterweight.

White House aides say there’s a good reason why blue-state governors might not have heard much from the administration lately. For the most part, officials have been focused less on larger Obamacare messaging and more on an intense effort to reach uninsured Americans, particularly in big states with uncooperative GOP governors, such as Texas and Florida.

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In places like these, the president, first lady Michelle Obama and Vice President Joe Biden have been touting the ACA on the radio, with an emphasis on black and Latino audiences. They’re also turning to social media: Administration aides have largely given up counting on the press to cover positive stories about Obamacare they’ve tried pumping out, and instead point to the viral traffic they got from having Julia Louis-Dreyfus and other celebrities tweet with the #getcovered hashtag.

“In the places where you have a high density of uninsured, you’d be hard-pressed not to find an active administration voice,” said a senior administration official. “We’re doing what we think works, and what we think reaches the most people.”

Still, in the absence of a stronger pro-ACA message emanating from Washington, governors — like Senate and House candidates — have essentially fought out the issue state by state. They have sought to persuade their constituents that they should accept federal funds for Medicaid expansion, work through the technical problems with numerous state exchanges and patiently await the benefits of the ACA’s transformation of the health care market.

At a POLITICO event after the Democratic governors’ meeting with Obama, Nixon said there hasn’t been enough emphasis on how states are working to “get better health outcomes” within the larger framework of the ACA. “Having the administration and others talk more about those reforms within the Medicaid system, I think would be helpful,” said Nixon, a popular Democrat who has been blocked from accepting federal health care funds by a GOP legislature.

Markell, a mild-mannered businessman-turned-politician, said he had lobbied Obama health care adviser Phil Schiliro to broaden the White House’s ACA-boosting message beyond the “pre-existing conditions” story line.

“They have to continue to tell the story around cost, because in that case we hear some good stories and some stories that are not as compelling,” Markell said, adding of his conversation with Schiliro: “He was certainly very receptive. Everybody we’ve talked to about that has been receptive and understanding.”

That, for many Democratic governors, is the irony of their interactions with the White House and other national Democrats around the health care law. Democratic state leaders have relatively little to say in the way of criticism when it comes to the administrative side of Obamacare and their ability to get the waivers and other administration favors they need to massage the implementation process.

“[HHS Secretary] Kathleen Sebelius has been very easy to work with,” said Arkansas Gov. Mike Beebe, a Democrat whose cooperation with state Republicans on Obamacare has provided some hope to Democrats with divided statehouses.

The political side is another story.

As the administration sees it, it makes sense at this point to focus on reaching states and regions with the highest density of uninsured voters.They’ve also been participating in conference calls with state officials and activists working on implementation — including one on Monday — and pushing soft-media stories about health care. Booking Michelle Obama on “The Tonight Show” or Joe Biden on “The View” are very much part of a larger strategy from a White House that feels there’s more to be gained outside hard-news media than through another presidential speech or press conference.

On issues like cost containment, the White House believes it will have more to tell the public once the implementation process has advanced further and there are more data on aspects of reform like physicians switching over to electronic record-keeping.

In political briefings, White House and party officials have counseled Democrats, including governors, to embrace the law to whatever extent they can and go after the GOP for wasting time “repealing settled law in order to put insurance companies back in charge [and] roll back protections against discrimination for pre-existing conditions,” according to one Democratic strategist. What’s more, for some red-state governors and candidates, strategists and administration officials agree that a healthy distance from Obama could help some Democrats more than an enthusiastic round of health care cheerleading from Washington.

Democrats say that other groups, including labor unions, abortion-rights groups and the pro-reform groups like Americans United for Change and Protect Your Care, will also switch over to a more publicly assertive, ACA-boosting message once the enrollment phase winds down.

Vermont Gov. Peter Shumlin, chairman of the Democratic Governors Association, said he expects Democrats this year to go after Republican governors who have refused to accept federal health care money for putting ideology above their constituents’ practical needs. He declined to say whether DGA would run pro-health-reform ads in the midterm cycle.

“I hardly think the DGA has to make the connection to a family that has always wanted health care, wakes up in the morning wondering whether their kids are gonna get sick,” said Shumlin, who noted: “We didn’t vote for the Affordable Care Act. Voters understand that. We didn’t pass it … We were asked to implement it.”

Shumlin, who recently devoted his entire state of the state address to a single subject — heroin addiction — in an attempt to harness public opinion for his agenda, had little to say about how the White House might turn the larger tide of public opinion on this particular issue.

“I guess I haven’t thought much about that one, to be honest,” he said.

Kentucky Gov. Steve Beshear, the lone governor whose ACA implementation efforts Obama singled out in this year’s State of the Union address, argued that the health care law will be its own best advocate as more voters come to experience the benefits firsthand. Beshear said ACA critics “act like they’re in an echo chamber,” pointing to Senate Minority Leader Mitch McConnell, the Kentucky Republican fighting a competitive reelection race this year.

“I certainly believe that this November, in the election, if the senator tries to use the Affordable Care Act as a tool in his campaign, that it will backfire,” Beshear said. “It’s an exciting time, quite honestly, to be in Kentucky with health care.”