“David Nather” - Health care fight: Round 2

DAVID NATHER & J. LESTER FEDER

3/14/11

http://www.politico.com/news/stories/0311/51207.html

When President Barack Obama signed health reform into law a year ago, Democrats hoped the public would learn to love it.

It hasn’t.

“If public opinion was going to shift, it would have shifted. It hasn’t moved a lot in a year,” said Robert Blendon, an expert on health care and public opinion at Harvard University.

In fact, the one notable change in recent months isn’t a good sign for Obama — 57 percent of independent voters had an unfavorable view of the law in January, up from 41 percent in December, according to the Henry J. Kaiser Family Foundation.

Unless that situation changes, the 2012 campaign could easily be one in which the Republican presidential candidates talk about the health care law more than Obama does — and so will the GOP challengers to the 23 Senate Democrats up for reelection.

As they brace for that clash, both sides are testing talking points and honing strategies to boost or blunt the health care law’s impact on their political fortunes.

Scenario A: Republicans on offense

The Republican candidates have every reason to attack the law. It’s what their base demands, and it plays into the nonstop barrage of negative news about the law, from the lawsuits to the Republicans’ repeal efforts.

In addition, those messages could counter a White House strategy to de-emphasize the issue. The voters who support the law are a lot less enthusiastic than the ones who oppose it, according to most recent polls, and that situation hasn’t changed during the past year.

That’s why Republican pollster Bill McInturff says repeal should be a central focus of the GOP presidential campaigns — not just in the primaries but in the general election, too. “The Republican nominee for president is going to run, and has to run, on repealing this bill,” he said.

Republicans are also hoping for an assist from the third branch of government, the judiciary.

The timing of the lawsuits challenging the law — especially the individual mandate to buy insurance — could lead to a Supreme Court ruling in fall 2011 or early in 2012, just as the presidential campaigns are getting under way.

If the court strikes down the mandate on constitutional grounds, Republicans will pocket some major crowing rights, and the White House will have a lot of explaining to do with voters.

Even if the court case doesn’t reach the Supreme Court before the 2012 election, a series of negative lower court decisions could saddle Democrats with an endless stream of bad news about the law and ease pressure on Republican candidates to come up with an alternative.

“It’s a sucker punch to try to force the Republicans to come up with a plan that you can then attack,” said former Rep. Tom Davis of Virginia, who’s now the president of the Republican Main Street Partnership, a moderate GOP group.

And Jenny Beth Martin, a tea party activist, said the Republicans’ only real priorities should be to “repeal the law and get our budget under control.”

At some point, though, the Republican nominee will most likely be forced to come up with a GOP health care plan. The spiraling costs of Medicare are a major contributor to the growing national debt. In addition, controlling health care costs has long been a priority of the business community and voters.

For the past three election cycles, candidates were expected to have a platform plank on health care. And once the Republican nominee has one, the party’s Senate and House candidates will be tied to it.

The key for the GOP will be timing: inflicting maximum damage on Democrats before the latter can turn the tables on Republicans.

Scenario B: Democrats on Offense

There are signs that give Democrats hope.

A recent Kaiser Family Foundation poll shows widespread confusion about the status of the health law — 48 percent think it’s either been repealed or is not being implemented — which means there is a lot of room to educate voters.

In addition, individual provisions of the bill — including the ban on pre-existing condition exclusions, support on premiums for moderate-income Americans and better prescription drug coverage for seniors — have support of more than 70 percent of Americans.

“Campaigns are always about the future, not the past,” said Paul Begala, a Democratic strategist and former aide to President Bill Clinton. “The president can say, ‘Reelect me, or [Republicans] will take away your rights and give them back to insurance companies.’”

With Obama leading the Democratic ticket and growing numbers of the law’s provisions taking effect, the GOP could increasingly find itself on the defensive for trying to eliminate its popular elements. “You will have a bully pulpit where you can articulate” the law’s advantages, said Democratic pollster Celinda Lake.

Washington Sen. Patty Murray, who chairs the Democratic Senatorial Campaign Committee, told POLITICO that the law is “actually really helping” voters as its provisions take effect. If Republicans keep up efforts to gut the law, she said, “It’s going to be unpopular to say that you’re going to take something away from people.”

Another potential edge for Democrats would emerge if the Republican presidential primary is won by former Gov. Mitt Romney, who signed a similar health care reform into law in Massachusetts.

Romney is already testing campaign messages that he hopes will distinguish his effort from that of the White House by calling for repeal of the national law while saying the Massachusetts law was never meant to be a solution for every state. But so far, influential tea party leaders aren’t buying it.

“It’s still going to be a really hard sell for people, especially since Obamacare was modeled so closely on Romneycare,” Martin told POLITICO. Of Romney’s insistence that the Massachusetts law isn’t the answer for every state, she said, “People are going to see that as semantics.”

The Democrats also will be prepared to pounce as soon as a GOP alternative emerges.

So far, the main Republican proposal on the table is the “road map” offered by House Budget Committee Chairman Paul Ryan of Wisconsin, which includes a proposal to replace the popular Medicare program with vouchers for the purchase of private insurance.

The politics of this would be “fabulous,” Lake said. “Voters are wildly against it. If you accompany that with the Republican agenda to privatize Social Security ... that goes a long way to regaining that senior vote we lost by 20 points.”

Indeed, Obama and the Democrats will accuse Republicans of abandoning seniors to the whims of the insurance industry — an attack that helped stymie action on reform for years.

“Health care has always been World War I trench warfare,” Begala said. “It’s always been won on defense — whoever is advancing is getting gunned down.”