The sweeping health overhaul law turns 2 years old this Friday. And as it heads toward a constitutional showdown at the Supreme Court next week, the debate over the measure remains almost as heated as the day President Obama signed it into law.
In fact, public opinion about the law remains divided along partisan lines to almost exactly the same extent it was when the law was signed on March 23, 2010, according to the latest monthly tracking poll from the Kaiser Family Foundation.
Democrats mostly like the measure. Republicans mostly hate it.
Michael Cannon, an opponent of the law who works for the libertarian Cato Institute, says he's not a bit surprised that its popularity hasn't grown as many Democrats predicted it would.
"Even if this law was written exactly as its supporters would have liked, you still can't put lipstick on this pig," he says. "The law just takes too much from too many people to be popular with the American public."
Opponents of the law say the main reason for that is the so-called individual mandate, which requires most Americans to have health insurance or pay a fine starting in 2014.
"There was something fundamentally different about trying to jam the individual mandate down the throats of the American people," says Tom Miller, another opponent of the law from the conservative American Enterprise Institute. "Even people who had insurance, who were buying it — it just didn't resonate with their core gut instincts and larger values and history."
But supporters say the reason the law hasn't won more love is considerably more complicated.
Princeton sociology professor and health care watcher Paul Starr says part of the problem is that so much of the law hasn't taken effect yet. "They're only really going to become aware of the specifics of the legislation as we get close to the point where there's enrollment in health plans and where people actually see how the health insurance exchanges actually work and how the subsidies work," he says.
And there's another big factor in the the lack of support — a lot of people who might like the law misunderstand what it actually requires.
For example, in a March 2011 poll, Kaiser (like most other groups polling on the subject) found that two-thirds of respondents said they opposed the individual mandate. But when it was explained that in most cases simply having employer-provided insurance would satisfy that requirement and that most employers were expected to continue to provide such coverage, opposition dropped to 35 percent.
"Probably 95 percent of the voting public either meet the individual requirement or are exempt from it," says Chris Jennings, a former health aide to President Bill Clinton and a supporter of the new law. "Why aren't these messages coming through better than they obviously are?"
It probably doesn't help that the Obama administration has been spending more effort trying to put the law into effect than working to dispel some of the myths about it.
"I don't think that was our primary job," says Nancy-Ann DeParle, White House deputy chief of staff and one of the key administration architects of the health law. "I really think our primary job was making sure that the changes that are happening to our insurance system were implemented in a careful, deliberate, transparent fashion."
DeParle blames the misperceptions — particularly about the pivotal individual mandate — on the law's many political opponents. She says, "The fact is for the vast majority of Americans they'll just check a box that says, 'Yes, I have insurance.' "
But the administration's lack of messaging, not to mention the political polarization around the law, has frustrated some of the law's other supporters.
"What messaging?" asks John Rother, who runs the nonpartisan National Coalition on Health Care. "I think the problem with something that's this controversial is it's always much easier to criticize it is than to defend it. And given that, I think the advocates for the legislation have been missing in action."
Princeton's Starr says there's another reason that opponents of the measure outnumber supporters. The entire structure of the law — preserving a private insurance system with an individual insurance requirement — was originally a Republican idea. "The president and Democrats adopted that approach in the hope of getting moderate support," Starr says.
Yet Republicans have unanimously turned against it. And they're not the only ones.
"Many liberals were never enthusiastic about it to begin with," says Starr. And that shows up in the polls. "Many of the people who are unfavorable are actually unfavorable from the left and are unhappy about the law, because it isn't a single-payer national health insurance plan."
That may be yet another reason President Obama spends a lot more of his time on the campaign trail these days talking to his Democratic supporters about things other than health care.
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