Three years after it passed, President Barack Obama and fellow Democrats are still trying to sell the federal health care law to a skeptical nation.
Lawmakers, armed with tool kits and fact sheets, are fanning out across the nation to tout the law’s benefits. Those charged with implementing its changes, starting with Health and Human Services Secretary Kathleen Sebelius, are pushing companies to donate money to a private group that’s working to get the program up and running. Supporters are organizing armies of volunteers to go door to door to try to sign up millions of uninsured Americans.
Obama, too, is touring the nation to talk up the benefits. His most recent speech – Friday in San Jose, Calif. – focused on the promise of lower premiums in the state that has the largest insurance market, as well as on the Republicans who’ve been relentless in criticizing the law.
“It’s basic trench warfare,” said Stuart Altman, an economist at Brandeis University who specializes in health care policy. “It’s symbolic of the split in the country.”
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Ever since the creation of Social Security in the 1930s, the government often has had to explain or sell new social programs to the country. But the campaign to sell this law is far greater than any other in recent history, including the Medicare prescription-drug benefit enacted in 2006, political and health care experts said.
As ever, politics drives the debate.
Democrats say they have no choice but to sell the law to the public because Republicans and their allies are aggressively spreading misinformation, discouraging people from enrolling and refusing the additional money the administration says is needed to implement the changes. The law included $1 billion for implementation, but the nonpartisan Congressional Budget Office says it will take $5 billion to $10 billion, and Congress won’t appropriate any more. Also, some GOP governors are rebuffing efforts to expand Medicaid, the government-run health program for the poor and a key part of the law.
“The Republicans in Congress are hellbent on doing whatever they can to help this fail,” said Mo Elleithee, a veteran Democratic political consultant.
A Democratic-controlled Congress passed the Patient Protection and Affordable Care Act, dubbed Obamacare, in 2010. The Supreme Court upheld the constitutionality of the law last year.
Republicans haven’t given up, working to eliminate, defund or minimize the law. The House of Representatives, now run by Republicans, has voted 37 times to repeal it, symbolic votes that die in the Democratic-led Senate.
“The president has shown over and over again that he is good at campaigning, but not so good at governing,” said Sen. Minority Leader Mitch McConnell, R-Ky. “All of the campaign-style events in the world won’t mask the fact that Obamacare costs too much: too much for families, too much for businesses and too much for taxpayers.”
Whatever the reason, Americans are skeptical. A new Wall Street Journal/NBC poll released last week found that 49 percent of Americans think the law is a bad idea. That number has gradually increased in the same poll since 2009. About 37 percent think the law is a good idea. Other polls show similar results.
That may be part of the reason the Obama administration is working to arm its allies.
Two weeks ago, for example, the White House, the Health and Human Services Department and the Small Business Administration held a series of sessions for lawmakers, chiefs of staff, legislative assistants and press secretaries on the implementation of the law and how to talk about it. In the House, members were issued a tool kit: a binder of information about the law, including responses to Republican “myths.”
There’s also the public relations pitch financed in part by the private sector – with a push from the government.
Under questioning by Congress, Sebelius testified last week that she’d been forced to ask companies and organizations – even some that her department regulates – to help a nonprofit group promoting the health care law because Republican lawmakers refused to provide the millions of dollars necessary to implement it.
She said she called five companies – Johnson & Johnson, the drug maker; Ascension Health, the large Roman Catholic health care system; Kaiser Permanente, the health insurance plan; H&R Block, the tax preparation service, which is helping low- and middle-income people apply for tax credits that can be used to buy private health insurance; and the Robert Wood Johnson Foundation, which works in public health.
Sebelius said the Public Health Service Act granted her the authority to urge groups to get involved and that her actions were similar to those in Bill Clinton’s administration to encourage enrollment in the Children’s Health Insurance Program and George W. Bush’s administration to help Medicare beneficiaries sign up for prescription drug coverage.
The nonprofit group that’s helping to implement the health care law, Enroll America, is led by and supported by former Obama aides. Recent reports say that President Anne Filipic, a former deputy director of the Office of Public Engagement, will send volunteers door to door to enroll uninsured Americans while another former White House staffer, Nancy-Ann DeParle, is raising money for the group.
Meredith McGehee, the policy director for the nonpartisan Campaign Legal Center, said it wasn’t all that unusual for Congress to pass a bill and then not follow through with more money, forcing supporters to collect private money to implement it.
But, she said, it’s unusual for a high-profile figure such as Sebelius to ask for money from companies she regulated. “She’s crossed the line, because they’re going to think, ‘What’s going to happen if I don’t give?’ ” she said.
Republicans lawmakers have launched investigations into the fundraising, saying Sebelius is trying to circumvent limits on spending set by Congress.
“That’s bullying, plain and simple,” said Sen. Orrin Hatch, R-Utah, “and promotes a ‘pay to play’ environment that undermines the public trust in government.”
In his speeches, Obama has avoided the controversies and focused on facts to make his case (here’s one: 25 million uninsured Americans will gain coverage by 2023, according to the Congressional Budget Office) while treating the events like campaign rallies, complete with supporters and Republican jabs.
“This is working the way it’s supposed to,” the president said last week in San Jose. “So the bottom line is you can listen to a bunch of political talk out there – negative ads and fear mongering geared towards the next election – or alternatively you can actually look at what’s happening.”