It may be difficult to see from here, but there is little doubt that the Patient Protection and Affordable Care Act will eventually take its rightful place alongside the most cherished social programs such as Social Security and Medicare. Yes, it must first pass judicial review and get fully funded and implemented. And based on the current divisions in the country over the law, it has a ways to go before it achieves this exalted status. But the law's passage is a tribute to the perseverance, leadership and courage of those who worked to pass it -- especially then Speaker Nancy Pelosi, D-Calif., who found a way to herd enough cats to secure passage.
The federal health law traveled a rocky road just to get where it is today. Prior to the law's passage, there were some early message battles that were clearly lost. Advocates started out talking about the right values and principles behind the reform effort such as keeping your insurance if you like it and ending denials based on pre-existing conditions -- all of which have always been immensely popular with the public. But once the attacks began, they were difficult to counter because there was no specific bill to which advocates could point. And there were always deep divisions about the law between those with health care insurance and those lacking coverage.
Many of these first-wave attacks were false, misleading or even outrageous, including those based on "death panels," cited by PolitiFact as the 2009 political lie of the year, and the claim that the law would cut Medicare when in fact it strengthens the traditional program and saves taxpayers billions by reducing excessive private insurance profits in Medicare Advantage. Seniors were always among the most skeptical demographic groups because they were fearful that any health system change would impact Medicare. These lies, though, achieved their desired end of reducing support for reform among older Americans and women. In April 2010, a GWU Battleground Poll found just 39 percent of seniors supported the bill, while a majority, 56 percent, opposed it.
Once the House drafted a bill, there was a perilous waiting period between House and Senate action that lasted for months. Having three separate bills also had a negative impact on public support. It served to foster even greater confusion about the substance of health care reform legislation and made it difficult to push back on attacks made against the reform effort.
Once the health overhaul finally passed, advocates could point to what the law would actually do for regular Americans, especially for the 80 percent who already had health insurance coverage. In the past year, the measure got a critical boost from several key early implementation milestones, including extending coverage for young adults; eliminating pre-existing conditions for children; the down payment it made on the closing of the Medicare prescription drug doughnut hole; coverage of preventive health services for seniors; prohibiting arbitrary insurers from canceling coverage when a consumer gets sick; eliminating secret limits on lifetime and annual caps; and enacting small-business tax credits. Polling during the latter half of 2010 showed a small but significant bump in support for the law as awareness of these real benefits began to increase. Slowly, more Americans are coming to understand the law's valuable patient protections, and they will oppose having those taken away.
Support for the law was also hurt by insurance company decisions to raise rates when what most people wanted from the law was to reduce costs and premiums. Fortunately, the law's provisions provide additional powers to states to further regulate insurance company premium increases -- an idea firmly supported by public opinion. These provisions have already served as a check against the most egregious rate increases, as insurance companies abandoned some of their plans once they received negative press on the issue. Another recent shot in the arm for the law came with the announcement of $4.3 billion in savings from a crackdown on Medicare fraud and waste, which has become an important populist proof point for advocates in an era of deficits and concerns about government spending.
In the near future, the law still faces significant challenges. The House this year cast a symbolic vote to repeal it and is threatening its funding through the budget process -- despite the fact that a recent Kaiser Family Foundation tracking poll found that 64 percent of Americans oppose cutting off funding for the law, and just 30 percent support ending its funding. (Kaiser Health News is an editorially independent program of the foundation.) If Republicans take back the Senate and the White House in 2012, they may be able to fully repeal it. Equally pressing, within the next year or so it is widely anticipated that the U.S. Supreme Court will review the law in the wake of the various lower court decisions that have been handed down. In the meantime, some individual states have taken it upon themselves to drag their feet on implementation of the law and have gone so far as to reject federal funds earmarked for that purpose. This flies in the face of the will of the American public, fully half of whom want to expand the law (30 percent) or keep it as it is (20 percent), while fewer Americans want to repeal it and replace it with a Republican alternative (18 percent) or repeal it and not replace it at all (21 percent).
But if the health law survives this gamut, by 2014 it will help tens of millions of Americans in myriad ways. It will eliminate all denials for pre-existing conditions, fully close the Medicare prescription drug doughnut hole and use health exchanges to provide affordable coverage to those who currently lack it. Furthermore, the provisions that change the health care system -- though not well understood by the public -- also have very significant potential to empower patients while helping the system to deliver higher quality care at lower costs. If given the opportunity, these reforms and protections will eventually make the Affordable Care Act politically unassailable.
Celinda Lake is the president of Lake Research Partners, a public opinion and political strategy research firm. David Mermin is a partner and Dan Spicer is a senior analyst.