Happy birthday to healthcare reform. Unfortunately, after that long battle, and all the money spent not only to implement the law but to educate Americans who know little about it, the law remains even more unpopular than when it passed a year ago and the cost of healthcare insurance remains prohibitive and continues to rise.
Democrats, who lost their majority in the House in the midterm elections last fall, in part due to healthcare reform, won't campaign on it next year, just as they didn't last year. But on its anniversary they are going all out to try and budge public opinion on reform, which has proven quite stubborn. The most recent polling by the Kaiser Family Foundation found 42 percent of respondents approved of the law while 46 percent opposed it, a bit worse than the average polls on the law since it passed. The survey also finds a majority of respondents are confused about what the law does and whether or not it has been repealed.

The marketing campaign under way aims to make sure Americans get past their confusion to learn that benefits now available from the law include: the ability for children up to age 26 to remain on their parents' insurance plans, free preventive screenings, $250 rebate checks for seniors who fall into the Medicare prescription-drug "doughnut hole," the assurance that children with pre-existing conditions can buy health insurance, a ban on lifetime caps for benefits and insurance companies now being required to spend more than 80 percent of revenue from premiums on healthcare services.
Later on, the going gets tough. In 2014, the mandate to buy insurance (or pay a fine) will kick in, as well as some taxes. The expansion of Medicaid, which the law intends to cover half of the new 32 million covered, will face considerable resistance from bankrupt states struggling with their current obligations while trying to reduce significant deficits. And how will the fundamental cost control be working by 2014? The law created high-risk pools designed to offer affordable coverage to patients with pre-existing conditions by increasing competition between insurance companies and thereby lowering costs. Thus far approximately 12,500 people have joined these pools — only 3 percent of the number the administration had estimated would do so. To lower the cost of healthcare, membership in those pools will have to grow considerably.
Efforts are still under way in Congress to defund the healthcare law, though they aren't likely to be successful with Democrats controlling the Senate and President Obama in the White House. But in addition to a majority of states filing for waivers from the law and passing legislation opposing parts of it, numerous court challenges to healthcare reform are making their way through the system and it is likely to be decided by the Supreme Court, probably before the 2012 election. The rejection of the individual mandate by the Supreme Court would build more political momentum against the law, and should Republicans win a majority in the Senate — as now appears likely — even if Obama is reelected, the law will likely come under significant legislative attack and could unravel. Should the Supreme Court back the mandate, that would likely end the fight against reform and probably improve the popularity of healthcare reform over time.
For now, as it was last year and the year before, selling healthcare reform is still a tough slog for Democrats.

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