Obama faces new conundrum in selling his healthcare law

The Obama White House is grappling with an unusual reality as next year’s election looms: The signature domestic achievement of the president’s first term seems, at best, as much of a liability as an asset.

When healthcare reform passed in March 2010, President Obama hit the road to tout its benefits. Supporters predicted that the law would grow more popular as temperatures cooled and the public learned more about what it actually does.

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Neither has happened: The law still polls unfavorably, and the public knows even less about what’s in it. And it’s a far smaller part of Obama’s rhetoric.

Democratic operatives say the president is now faced with a conundrum: The benefits of healthcare reform will almost inevitably fade from public view if he does not use the bully pulpit to remind people of them, yet the nation is hardly in the mood for anything that could be perceived as bragging.

“You just don’t have the luxury to talk about, ‘This is what I’ve done’ in a country that has really big economic problems,” Democratic strategist David Beattie said. “This is not a time that you can rest on your laurels.”

Friday’s news that the economy added zero jobs for the month of August only deepens Obama’s problem.

Republicans, who opposed healthcare reform from the beginning, are bullish on the issue.

“The bill has just not paid a political dividend for the Obama White House over time,” GOP strategist Matt Mackowiak said. “Every argument for it has been discredited over time.”

Healthcare advocates dispute that view, of course, and they also aren’t ready to concede a messaging failure. They say there are unique challenges to selling this particular measure and that they’ve always expected a long haul, especially after such a bruising legislative debate.

“It takes a constant drumbeat of information — consistent information — for people to grasp and hold onto something, especially when it’s not there for them yet,” said Kathleen Stoll, director of healthcare policy at Families USA. “That drumbeat isn’t as steady a rhythm as we’d like when you have inserted into that a lot of misperceptions and falsehoods about the law.”

Democratic strategist Chris Lehane said the healthcare law is hard to sell, politically, because people will not receive anything tangible that underlines its benefits. Everyone who gets a Social Security check or a Medicare card has a tangible connection to those programs, but there’s no corollary under the Affordable Care Act.

Even one of its most popular benefits — a ban on denying people coverage because of pre-existing conditions — could have limited political appeal, he said.

“That’s a very significant reform,” Lehane said. “But unless you have already been denied coverage, it would not necessarily be something that you would know about.”

Requiring insurers to cover everyone is among the most popular benefits of healthcare reform. Many of its components poll well on their own, often far better than the overall law. But some of those popular provisions don’t take effect until 2014. And as much as people might like the sound of certain benefits, they often don’t connect those policies to the Affordable Care Act.

For example, the law makes some preventive services available without cost-sharing. Two-thirds of the people surveyed in a recent Kaiser Family Foundation poll said they support that benefit, which the Obama administration has begun to implement. But more than half incorrectly said free preventive care isn’t part of healthcare reform.

Knowledge of more significant provisions is also slipping. In June 2010, 72 percent of those surveyed for the same Kaiser tracking poll knew that the law provides financial assistance for low- and middle-income people to buy insurance. Now, that has fallen to 58 percent.

Neera Tanden, COO at the Center for American Progress, said it’s not unusual for the public to need some time to connect policies with the laws that contain them. Healthcare will be no different, she said, and awareness will grow as more of the law takes effect.

“It is an ongoing challenge that we have to make people aware of the benefits of the law ... There’s some work to do here, but it remains fundamentally the case that the actual benefits in the law are things people support,” Tanden said.