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Where Dems go from here

Passing healthcare reform is an accomplishment of historic proportions, even though, on the eve of victory, only 45 percent of Americans were willing to label it even a major feat. After successes of such magnitude, the tendency is either to sit back and savor the accolades or to move on to tackle yet another legislative challenge. 

However, while this achievement will be lauded by history, future plaudits will not win this year’s elections.

Though Democrats must turn the focus to jobs, consigning discussion of healthcare to the dustbin of history could prove nearly as devastating as having failed to pass the bill in the first instance.

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Recent polls have found margins ranging from four points in favor of the bill to 20 points opposed. As we have pointed out previously, some of that opposition comes from the left. A recent CNN poll found 39 percent in favor of the plan and 43 percent opposed because the plan was “too liberal.” The “swing” is provided by the 13 percent who said they were opposed because the legislation was “not liberal enough.” 

As we also argued earlier, most Americans remain ignorant of the contents of this bill. Make no mistake, though — voters may not know what’s in the bill, but the truth is they do not particularly like the vague impressions of it they now have. Nearly two-thirds expect their cost for healthcare to increase; 70 percent think the bill will increase the deficit; and a third to a half think their family will be worse off as a result of this reform.

Inevitably, real-world events will also conspire to complicate life for supporters. Premiums will go up, as they would have anyway, yet supporters of the bill could own post-enactment rate hikes. Insurance companies will still treat patients poorly, but now Democrats will own part of the problem. Not to mention the Medicare cuts and new taxes on Cadillac insurance plans, which remain deeply unpopular, and which supporters surely own.

Nevertheless, much in this reform does enjoy widespread support. Voters want to prevent insurance companies from denying coverage based on pre-existing conditions; they want to require insurers to pay legitimate claims; they do not want insurance to be taken away when people get sick or lose a job; they even want to expand coverage to the uninsured.

Beyond those overarching arguments, there are a host of provisions that deeply and positively affect niche audiences. Many parents with kids up to 26 want to be able to keep insuring their children on their own policies. Seniors want the prescription drug doughnut hole closed.

But voters will not know about these benefits unless Democrats make a concerted effort to sell them — hard and repeatedly over the next eight months. 

Equally important, Democrats can and must put Republicans on the defensive. In calling for repeal of the bill, Republicans now want to allow insurance companies to deny coverage for pre-existing conditions; Republicans want to allow insurance companies to take away coverage when people get sick; they want to force seniors to pay more for prescription drugs; they want to stop 22-year-olds from being covered under their parents’ policies. Democrats need to make Republicans shoulder those heavy burdens. 

Failure to pass healthcare reform would have been a political disaster. Passing it could still be a liability if the reform is left a vague negative in voters’ minds. Even as efforts to create jobs and make America energy-independent take center stage, Democrats must keep some message focus trained on healthcare.

Mellman is president of The Mellman Group and has worked for Democratic candidates and causes since 1982. Current clients include the majority leaders of both the House and Senate.