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Democrats And Republicans Angle For Public Support In Health Law Debate

Jan 20, 2011

Brace yourself: the war of words over the health care law isn’t going to end anytime soon, not with both parties seeing new opportunities to mold public opinion in the wake of Wednesday’s largely symbolic House repeal vote.

"The vote on repeal is the overture to the great opera," says Stuart Butler, director of the Center for Policy Innovation at the conservative Heritage Foundation. "It's just the opening of what's going to be a very long, tortured and very emotional debate for months and years to come."

It’s not just Republicans who see a great way to gain public support by keeping the law front and center in 2011. Democrats think the GOP-driven debate gives them another chance to re-sell the benefits of the law. Polls show opinions on the law haven’t shifted much, but advocates and opponents share the belief they’ll score points the more people learn about various provisions.

Both parties also face risks, say independent experts and advocates. Republicans could overplay their hand and overwhelm a public already fatigued by lengthy debate. Democrats stand to lose ground if a law so closely identified with  President Barack Obama doesn’t gain traction going into the 2012 election year.

Although public perceptions of Obama are affected by feelings about the law,  perceptions of his overall performance can also affect attitudes towards the law, says Evan Tracey, president of Campaign Media Analysis Group, which tracks political advertising. "When you have made this 'Obamacare,' if the president's brand improves, by definition so too does the public's view of health care," he says.

But if the president's "approval ratings stay in the 40s,” Tracey says, “health care will stay down there with him." He says Democrats may want to consider decoupling the policy from Obama, "but that's difficult to do."

Tracey speculates that Obama might use his State of the Union address Tuesday to showcase a new and improved message on the law’s benefits. After the law was enacted last March, he says, Democrats "left it by the side of the road like a cup of coffee" and drove away.

Republicans took advantage and pounded away at the law during last year’s elections. This year, they shouldn't have trouble keeping the issue in the public eye, Butler says: While Americans usually have a short memory for political events,  "so many facets" of the law will roll out over the next few years that it will have "a longer political shelf life." For example, the new exchanges where individuals and small businesses will buy insurance, the Medicaid program expansion and the requirement that almost everyone carry health insurance will not take effect until 2014. 

Meanwhile, there will be well-publicized battles in the states over the law’s multi-year implementation, the lawsuits challenging its constitutionality and new attempts to tweak the legislation in Congress. The House passed a resolution Thursday instructing four committees to write new legislation that could replace the health law.

With polls showing many voters supporting changes in the health system, including some of the law’s more popular provisions restricting insurers’ ability to exclude some people, Republicans have favored a “repeal-and-replace” strategy. There’s “plenty of time to put forward new proposals” before the next election, says Jim Dyke, president of the public affairs company JDA Frontline and former communications director for the Republican National Committee. In the House, he says, expect to see "an empowered committee structure that really explores solutions and puts that into legislation and provides a good deal of transparency."

Whit Ayres, a GOP pollster and co-founder of the polling group Resurgent Republic, says Republicans also will go after the "time bombs embedded in the health care law" that will "send costs through the roof." They "will continue to fight a rearguard action as various provisions come online," trying to defund parts of the law and targeting the process of writing regulations. If public opinion on the law remains what it is today, he says, Republicans don't need to worry about going overboard in their strategy.

But new rounds of attacks also offer the law’s supporters an opportunity to convince Americans it’s a good deal, says Ron Pollack, executive director of Families U.S.A., a liberal group. "GOP attacks are doing us a favor," he says, giving "us a new opportunity to show Americans what they are getting and what they'd lose."

Democratic pollster Celinda Lake, president of the polling firm Lake Research, says that strategy could be particularly effective with women, a critical voting group.  "They're the health care voters and the health care decision makers," she says. Lake cautions that Democrats need to shift the conversation from impact on the federal budget to stories of real people. "You win women back by telling them that if their kids have asthma and it's a pre-existing condition, they won't be covered anymore."

Attempts to repeal the law, says Lake, are “the first sign of tension that Republicans face of how do you keep the tea party base and still appeal to independent women who were the key swing voters in 2010 and will be again in 2012."

Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health, expects Republicans will "go after the big money—subsidies, Medicaid and the regulatory agencies" in the law. The Democratic strategy, he says, "has to be to get substance of what's in the bill back on the table," so the public doesn't "start cheering on Republicans" for cutting $20 billion here and there.

"The biggest mistake [Republicans] could make is to have another health care debate, because actually the people who want the bill either implemented or repealed don't want to debate it anymore. They want to debate the economy," says Blendon. "So their strategy has to be to take action, but not take up a lot of time discussing it."

jgold@kff.org

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