Will public warm up to health care reform?

There’s no reason why, in just one year, popularity of the Patient Protection and Affordable Care Act should have risen dramatically. Nor is it true, much as some people would like to spin it that way, that the single largest expansion of the social safety net in more than 70 years is a political albatross. The reality, however, is that both of those stories are far too easy – and it’s much too early to write them. 

Public opinion of health care reform hasn’t budged since January. Despite some blips, it’s changed very little since enactment. This is frustrating for supporters of the law like myself, who hoped that we could correct many of the misconceptions about the law through forthright public education. But it is worth acknowledging that despite the flood of money spent by the right and the drumbeat of “repeal” messaging, support for the bill has not diminished either. 

The reality is that this is a deeply complex, distorted and misunderstood issue. Even the notion of a simple “split opinion” poll doesn’t hold up.

Look deeper at the Kaiser poll above and three in 10 say they want Congress to expand the law. Only two in 10 want the law left alone and implemented as is. Four in 10 want the law repealed, meaning that a majority want the law in place or stronger. Remember, some of the unpopularity of this law comes from those who wanted more progressive reform — a public option, single-payer, etc. 

Far more disturbing is a February poll showing that nearly half of the public believes the law has already been repealed (22 percent) or don’t know whether it is still law (26 percent). 

So why, after a year, have we not made more progress in improving public opinion? On the proponents’ side, the absence of a communications “war room” has allowed all of the messaging to be dominated by opponents, with only fragmented and uncoordinated messaging in support. The recent creation of a good communications hub should begin to change that with more message discipline. 

Opponents of reform have several advantages: Negative messaging is easier than trying to sell positive change, and they are attempting to kill reform at a moment in history where there is widespread skepticism about government. Furthermore, the health care, insurance and pharmaceutical industries (who have much to gain) are sitting on their hands and money at a time where their voice is needed. It’s a hard fight. 

What needs to happen now is simple: Implement, implement, implement. The better job we do getting the details right, the more people will like the law. Most importantly, we need to pay attention to the public’s real concern, which is cost of care and insurance. Changing the payment and delivery systems are the only way to begin to bend the cost curve. 

This is a forum about politics, to be sure, but let’s not lose sight of the basic moral issue: regardless of polls and popularity, reforming health care was always the right and just thing to do — for millions of Americans. We can’t give up now.

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