Health Reform Faces Messaging and Implementation Difficulties

Social policy is 1% inspiration and 99% implementation.

Wilbur Cohen, 1913-1987, the man who built Medicare

The news of the day is two fold:

One, a CNN poll indicating only 40% of Americans approve of Obamacare while 56% disapprove.

Two, a Politico report entitled “Democrats Retreat on Health Care Cost Pitch.”

This retreat makes sense. Democrats sold health reform on the notions that it would contain costs and protect Americans against health plans.

Instead, the public sees 10% overall rises in premiums for 2010, as much as 20% to 40% in the small group and individual markets, and a four year delay before the uninsured are insured. What they see is not what they expected. Health reform becomes a hard sell in an economy that is growing worse instead of better.

According to the Politico report, the Democrats' health reform allies are shifting their message to defending rather than touting the health care legislation. They are dropping claims it will reduce costs and deficit, and instead promising to “improve it.”

In a conference call and PowerPoint presentation organized by FamiliesUSA, a staffer for the Herndon Alliance, which includes leading labor groups and other health care allies, such as AARP, AFL-CIO, SEIU, Health Care for America Now, and MoveOnled – sought to rally pro-reformers around a new message based on polling from three top Democratic pollsters, John Anzalone, Celinda Lake, and Stan Greenberg. This message is a softer-sell based on the idea that things will get better in time, you just wait.

Democrats are acknowledging the health care legislation has failed to grow more popular after its passage.Democrats seek to win over a skeptical public, and to defend the legislation — and in particular the individual mandate.

The health reform law has failed to impress people under 40, the elderly, Hispanics, and women. Women, in particular, fear that access to physicians will be reduced. Most of the public has not bought the message that health care reform will help the economy, reduce costs, and the deficit.

What isn’t said in the Politico report is that Democrats may fear the effect of an unpopular health reform bill on the November elections.

Not only might they lose political power, but election reverses would make implementation much more difficult. The reform bill’s success rest heavily on individual mandates and cooperation of individual states in organizing and enforcing insurance reforms through health exchanges.

If challenges to the constitutionality of the individual mandate and resistance to health exchanges and state-level insurance reforms succeed, implementation will be rocky.

This could happen, given the likelihood that over 30 states will have Republican governors.