How Democrats Could Finally Win the 'Obamacare' Debate

Jill Lawrence
National Journal

Democrats were ambushed in the 2010 elections by the ferocious backlash to “Obamacare.” There will be no excuse if they are unprepared for what could be a repeat assault on the campaign trail in 2014. But there are few signs so far of an all-out long-term effort to celebrate or at least sell this landmark law.

On the third anniversary of the Affordable Care Act, Democrats were greeted by new polling showing that its most popular provisions – such as a tax break for small business and help for seniors to pay for prescriptions -- remain its least recognized. The best known aspect? The unpopular requirement that most people buy insurance or pay a fine.

Republicans marked the run-up to the Saturday anniversary by appearing to settle in for a sustained battle to the midterms. They tried, as usual, to repeal the law on Capitol Hill. They launched a website (“Higher Premiums. Sky-Rocketing Taxes. Reduced Care. This Is Life Under ObamaCare.”) and a round of attack emails.

Some of the GOP tactics are amusing, such as a Buzzfeed parody from the National Republican Congressional Committee entitled “13 animals that are really bummed about Obamacare.” But others could be dangerous to Democrats if there is no counter-messaging.  For instance, Senate Minority Leader Mitch McConnell made a short video showcasing what he called the first regulations under the law – “20,000 pages, seven feet tall, and they’re just getting started.” He alleged that none of the law’s promises are panning out – perhaps slightly premature since most of “Obamacare” won’t take effect until 2014 and measuring its impact will take years.

Now it is true that over the past week, the Department of Health and Human Services sent a series of  “Affordable Care Act at 3” emails extolling the law. But they were bland good-government releases designed to publicize new benefits and explain how to enroll when health insurance marketplaces come online in October. It’s also true that Organizing for Action, the new group that arose out of President Obama’s campaign organization, held a series of “birthday parties” around the country (speaking to the converted, much?) and plans to focus this fall on helping people sign up for health insurance.

And yes, House Democratic leader Nancy Pelosi talked up the law on Capitol Hill. “What I love about it, and most people don't realize, it's about wellness, it's about prevention, it's about quality of care, it's about a big difference in the lives of the American people,” she said. A positive message, yet it was buried in an email headlined “Transcript of Pelosi Press Conference Today.” And it was lonely. In contrast with the GOP, Democratic Party emails all week were about every subject but the health law. Obama issued a short statement, but on the exact anniversary of signing the Affordable Care Act three years ago, he devoted his video address to gun violence.

The political case for "Obamacare" is going to have to be made by advocacy groups, party committees and politicians themselves. And it will have to be made non-stop via every viral and high-profile means available, at an intensity level that matches the few short hours devoted to the health law at the Democratic convention last summer. “They haven’t grappled with fact that this is going to be a continual fight. You cannot rest,” says Andrea Camp, a strategist who has advised groups that support the act. “You keep talking about it. It has to be top of mind, and that’s how you drive up the favorables on this.”

Amid the Republican onslaught, which may have peaked (troughed?) with Rep. Michele Bachmann’s insistence that the law “literally kills” women, children and seniors, what is there for Democrats to say? A few things:

  • They are proud of what they did. The bottom line here is that as a result of subsidies, Medicaid expansions and new insurance rules, coverage will become available to tens of millions of people who were too sick or strapped to get it under the current system.
  • People are already receiving benefits and more will start soon. Repeating this message and using specifics to drive it home is key. Free preventive services like mammograms, the guarantee that insurance companies must sell you a policy and can’t kick you off, the requirement that young adults be allowed to stay on their parents’ policies until they turn 26 – these are in force or will be. It is up to Democrats and supporters of the law to make voters aware that these stem from “Obamacare.”
  • Republicans don’t have a replacement for the law. They continually propose repealing it (“to protect families, workers and seniors from its devastating consequences,” as House Speaker John Boehner put it Saturday in his third-anniversary observance),  and vote to do so. But it’s a pointless exercise since Democrats control the Senate and the White House. Beyond that, nobody loves the old system – and that’s what we’d have if Republicans succeeded in their repeal drive, since they have no plan of their own.
  • The law isn’t perfect and it can be improved. All Democrats should acknowledge the obvious: The Affordable Care Act is big and complex and will evolve for years to come, and they should make clear they are open to tweaks and fixes. If a tax or other provision proves unworkable or hugely unpopular, alternatives should be considered. If paperwork is too complex, it should be simplified. If federal standards make insurance plans too expensive, changes should be weighed. If states want flexibility, they should be encouraged. Some of these things are already happening, and Democrats would be wise to brag about them as evidence that they are pragmatists interested in a law that works well for people, states and businesses.

Obama is obviously the face of Obamacare and it’s not clear yet whether that’s a positive or negative. By mid-2014, we’ll all know a lot more about the possibly related issues of his job-approval trend and how the rollout of the new insurance marketplaces, the heart of the law, is going. But Democrats and interest groups and the president himself can’t afford to wait until they know which is winning, the horror stories or the heartwarming ones. They’ve got to uncurb their enthusiasm and keep it out front for months if they want the public to warm to this law and the people who made it happen.

Correction: An earlier version of this story gave an incorrect title for Mitch McConnell. He is the Senate minority leader.