Why 'Obamacare' May Live

What happened to the health-care frenzy that turned town-hall meetings into fiery, occasionally physical confrontations and helped propel Republicans to a House majority last year?

While we obsessed over jobs and the national debt, it faded into the campaign woodwork.

Republican presidential candidates are still vowing to repeal the Affordable Care Act, of course, but they are mainly going after President Obama’s economic record. That makes sense because the lagging economy is by far the top concern of voters. It also makes sense because with each passing month, the health-care law is woven more tightly into the fabric of American life and becomes more difficult to unravel.

David Axelrod, Obama’s top political adviser, says Republicans will make a mistake if they dwell next year on repealing the law. “The American people want to move forward. If there are problems with reform, fix it. They don’t want to start all over again,” he told me.

Republican strategists acknowledge their party faces political challenges on health care. One is the reform bill was fully debated in 2010 and it’s rare that an issue is central to two elections in a row. Another is the energy level needed to fuel an effort to kill a major law. “It’s going to be awfully hard to repeal it,” says John Feehery, president of QGA Communications and a former top aide to House Speaker Dennis Hastert. “It’s hard to maintain the kind of anger that comes with repeal.”

A third problem, according to a GOP strategist familiar with health-care issues, is that supporting repeal means the eventual nominee will need an alternative to the Obama law. “That becomes messy,” this strategist told me, because the nominee presumably will want to continue certain popular benefits and “there’s not an easy fix to how to replace the rest of Obamacare that keeps those features.”

suggest that public antipathy to the law may have been misunderstood and overstated, with people lumped together as opponents regardless of whether they wanted to repeal the law or expand it. CNN surveys for more than a year have found that about four in 10 oppose the law as too liberal, while majorities support it or want it to be more liberal. A Bloomberg poll last month found 51 percent who wanted to see how the law works and 11 percent who said leave it alone; only 35 percent supported repeal. The latest Kaiser Family Foundation poll on the law found 63 percent opposed to cutting off funding for it, as some Republicans have suggested. More than half – 51 percent – said the law should be expanded or kept intact.

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Geoffrey Garin, a Democratic pollster, sees a difference in his 2009 and 2011 results. Two years ago, asked what issues were important for their vote, Republicans mentioned the health-care law. Now they talk about debt, deficits, and spending. “It’s less of a reference point for people. So in that sense the intensity has been lowered,” he says of health care.

Michele Bachmann is a good example. The Minnesota congresswoman often calls the and says she “will not rest” until it is repealed. She told conservative activists on a conference call last spring that if she ran for president, that would be her signature issue . When she got into the race two weeks ago, the only mention of health care in her announcement speech was a relatively tame single sentence halfway through: “We can't afford an unconstitutional health plan that costs too much and is worth so little.”

Democrats did not exactly mount a vigorous defense of the law in 2010. But Obama will be its chief defender this time, and he’ll have advantages that were not available to the hapless Dems running for the House and Senate. One is the klieg lights of a presidential campaign; whether it’s in ads, debates or speeches, people will be paying close attention to what the president says. “The best person to articulate the case for the law is Obama himself,” says Stephen Zuckerman, a health economist at the Urban Institute. “He will be the one explaining it and trying to put people’s minds at ease.”

The health-care law timeline will help. The least popular element of the law, the requirement that most people buy insurance or pay a fine, won’t take effect until 2014. But by November 2012, many popular provisions will have touched people’s lives.

To start with Medicare, according to the White House, nearly 48 million beneficiaries are now receiving free preventive care such as cancer and diabetes screenings as well as a free yearly “wellness” visit to their doctor. More than 4 million of them have received rebates and discounts on prescription drugs. At the other end of the age spectrum, the administration estimates that 51,000 children will be insured through an early provision requiring coverage of kids with pre-existing conditions. And an estimated 1.6 million young adults who would not otherwise have coverage will be insured by 2012 under a provision allowing them to stay on their parents’ plan until they turn 26.

“We view this as an important achievement. Certainly we’re going to run on it and not from it,” Axelrod says. “Ultimately it’s going to help provide greater security for middle-class people.”

Two of three ex-governors vying for the GOP nomination are touting their own health-care reforms, but Democrats could fairly argue that so far they haven’t been effective. In radio and in Iowa, says that in Minnesota, he “passed health-care reform the right way. No mandates, no takeovers.” His goal was to control costs. However, a of two central reforms concluded they were small-scale and hadn’t produced noticeable savings.

A video on Jon Huntsman’s website says that he “took on the tough. Health care. . No mandates. Free-market based. Not government-run.” Yet the Salt Lake Tribune that the overall rate of uninsured in Utah is unchanged at 11 percent, despite Huntsman’s goal of halving it.

Huntsman says in another video that he would repeal the health-care law because it’s “top-heavy” and “government-centric.” “Let the incubators of democracy work,” he says. “We’re going to learn some important lessons that will be very instructive” from states pursuing their own solutions.

That is, of course, exactly what Obama and his party have done, as the Affordable Care Act is patterned on the Massachusetts health-care law signed by Mitt Romney. The Boston Globe recently of the state law headlined “Romneycare: A revolution that basically worked.” The newspaper concluded that “the overhaul has achieved its main goals without devastating state finances.” That includes a national low of 2 percent uninsured. The Globe notes that “the remaining worry is future costs,” a problem the state is now.

So alone among the ex-governors, Romney signed health-care overhaul that worked so well the feds used it as their model. Yet he’s to run ads reminding GOP primary voters of that. Instead, he calls the federal law a “disastrous” federal power grab from the states and says it must be repealed. He promises to issue waivers to all 50 states, or at least set the process in motion, on his first day in office.

One event could upend the campaign: if the Supreme Court rules on the constitutionality of the health-care law or its insurance mandate in the weeks or months before the election. Perhaps, recalling the political furor and legitimacy questions after the court’s Bush v. Gore decision in 2000, the justices will wait – and health care will stay in the background, where most voters seem to want it.