With sweeping health care reform almost reality, another battle is about to begin to define what it means for a skeptical public.
Whether it is the Democratic definition that prevails or the Republican one, the outcome will have huge consequences for the 2010 midterm elections, and ultimately for President Barack Obama’s chances of re-election in 2012.
Starting Monday, a coalition of progressive groups — from labor unions to health care advocates — will sink millions of dollars into television advertising and sponsor grassroots events in swing House districts thanking Democrats for passing the law and highlighting its importance for average Americans.
“We’re going to let our friends know we are going to be there for them,” said AFSCME President Gerald McEntee. “We expect in three months, the American people will understand the bill and they will be happy and satisfied with it.”
Health care stakeholders — including drug makers and insurance companies — are also weighing a second, post-passage public relations campaign that would educate the public about future insurance options and streamline the enrollment process, which is scheduled to begin in 2014.
Republicans scoff at the idea that the Democrats can quickly turn around public opinion, which most polls show runs against the reform package. And they are vowing to bring relentless attention to those who cast the “yea” votes for reform.
“I don’t think any American is going to forget this vote anytime soon,” House Minority Leader John Boehner (R-Ohio) told POLITCO.
GOP veterans and challengers are already rallying around a campaign pledge to repeal the reform bill, although the chances of that getting past Obama’s veto pen are slim.
In addition, Republican attorneys general are lining up to challenge the law in court, and GOP governors and legislatures in more than 30 states are debating and passing legislation they hope will exempt them from its particulars.
But the Democrats do have one advantage — a four-year-old playbook on how to turn a controversial change in the health care system from a loser into a winner. Its author: President George W. Bush.
The issue for Bush was a new Medicare prescription drug benefit for seniors, commonly referred to among insiders as ‘Part D,’ enacted by a Republican Congress in 2003.
The measure was passed in a manner that was as controversial, confused, and razor-thin as the process Democrats have gone through to enact health reform. It passed the House near dawn on a Saturday after a roll call vote that was held open for nearly three hours until the GOP leadership could twist enough arms and flip enough votes for passage. The final tally: A largely party line vote of 220-215.
The drug benefit was scheduled to take effect in 2006. But in December 2005, about 50 percent of seniors viewed the benefit unfavorably, according to Kaiser Family Foundation surveys — despite a much publicized Bush Administration bus tour promoting the program. Just 28 percent viewed it favorably, in part because they’d seen no benefits, and because of residual resentment about the process for passing it, the polls showed.
Those numbers didn’t get much better in the early part of the 2006 election year, when the launch of the enrollment plan was fraught with mistakes and confusing instructions for seniors.
At that time, gleeful Democrats were predicting a November GOP slaughter because of frustration with the plan among older voters, who hold unusual sway in midterms because of the lower turnout.
But the Bush White House, with the help of the U.S. Chamber of Commerce, PhRMA and the insurance industry, launched an education campaign to help seniors understand the benefit and how to sign up for it.
Pacificare Life and Health Insurance Company, one of the companies offering coverage, even employed some digital magic to air a conversation between Fred and Ethel, the sidekicks from the “I Love Lucy” program, about the importance of the new drug coverage.
In June 2006, seniors were split 32 percent to 30 percent in their unfavorable and favorable views of the program, the Kaiser tracking polls showed. But by midsummer, millions of seniors had sorted through the various coverage plans and signed up for benefits.
And by November, the industry and the White House had reversed seniors’ views, with a clear majority holding a favorable view of their new drug benefit.
Of course, Republicans still suffered big losses in the 2006 election. But the drug benefit itself had fallen off the issues radar screen and the losses were attributed more to scandals, war, rising deficits and runaway spending — which tangentially included the decision by the Bush Administration to push through the drug benefit without paying for it.
Drew Altman, president of the Kaiser Family Foundation, said the key reason the public relations blitz worked four years ago was because “there were real benefits there that seniors valued. So, Part D sold Part D.”
That explains why Democratic activists are focusing their new pitch to the public on the short-term benefits that are included in the reform legislation.
For instance, as soon as the measure passes, parents will be able to carry their children up to the age of 26 on their insurance plans. Children with pre-existing conditions will no longer be denied care and putting a limit on lifetime benefits will be banned. And seniors who face unexpected drug price hikes because of a glitch in the Part D program will receive subsidies to help cover those costs.
Democrats are also banking on gaining some public support when patients and doctors realize that many of the ominous Republican predictions of a government takeover and other horrors do not occur.
But Andrew Stern, head of the Service Employees International Union, conceded that some Democrats facing tough re-elections must move quickly to protect themselves. In addition to airing commercials on their behalf, Stern said he is encouraging them to adopt “crisper, faster, descriptions” of the reform package and their reasons for backing it.
“It will sell itself with time,” said Stern, “but you don’t get that time in a competitive election.”
Obama also has agreed to help sell the package by making a series of public appearances applauding the legislation's passage and highlighting the unanimous Republican opposition to it. The president has also assured Democrats that he will sell the benefits of the package in the run-up to the November elections and beyond.
Administration officials are also preparing talking points and fact sheets that lawmakers can take home with them on their Easter vacation — after the expected final vote in the Senate on amendments to the package that remove some of the more offensive side deals, Obama advisers said.
And Obama's grassroots' Organizing for America machine is also expected to be galvanized to buck up Democrats who voted for the reform package, while MoveOn has already collected $2 million in pledges to help finance challengers against House and Senate members who opposed the legislation.
In addition, Americans United For Change will launch a round of advertisements and robocalls in the districts of vulnerable Republicans, accusing them of taking the side of insurance companies and denying their constituents access to health care that is as good as their own. Their first target is Rep. Michele Bachmann (R-Minn.), who will be the target of more than $100,000 in commercials set to begin this week.
Most of the biggest reforms in the package don’t take full effect until 2014. That’s when insurance companies will have to stop denying coverage to anyone with a pre-existing condition, and the exchanges intended to make the insurance market more competitive — and less costly — will begin operating.
To ensure Obama’s roll-out goes more smoothly than Bush’s, Families USA Executive Director Ron Pollack, a reform supporter, already is working to create a new non-profit group aimed at educating people newly eligible for Medicaid and insurance subsidies.
Pollack has pitched his idea to hospitals, insurance companies and drug makers — the same groups that bailed out the Bush plan — and he expects those industry groups to put millions of dollars behind a similar effort.
Ultimately, Pollack hopes to see 50 state-based offices that can launch a robust enrollment program for the roughly 30 million new health insurance customers envisioned in the reform legislation.
Mark McClellan, a former Bush White House official who supports passage of the reform package, said he believes Democrats have a shot at turning public opinion around marginally in the short term. But scoring big swings in public opinion could be years away.
“What really matters is showing people it really works. Some people will see benefits next year. But for most people it will not have a big effect — except maybe some increases in premiums — until 2014. That’s two election cycles away,” he said.