Will Health Reform Be a Key Factor in Midterms?

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From left: Karen Bleier / AFP / Getty; Jason Reed / Reuters

At the time, it seemed like a pivotal moment in American politics. When Republican Scott Brown pulled off a stunning upset in the special election to fill the late Ted Kennedy's Massachusetts Senate seat on Jan. 19, GOP leaders warned Democrats that pressing ahead with Barack Obama's still pending health care reform plan would be suicidal. "Every election this fall will be a referendum on this bill," Republican Senate leader Mitch McConnell told ABC in early March.

Democrats went ahead and passed the sweeping legislation anyway — and now, nearly five months later, McConnell's prediction looks off base. Voters are far more concerned about the stalled economy or soaring budget deficits than they are about health care reform. Discussions of health care today pale in comparison to the frenzied town-hall arguments of August 2009.

More important, perhaps, the law has steadily grown in popularity. A late-July Kaiser Family Foundation survey found that 50% of the public views the new law favorably, up 9 points from May, while the proportion of Americans who view reform unfavorably has dropped from 44% to 35% in the same period. In late June, more Americans (49%) told Gallup that the law's passage was "a good thing" than those who disapproved — the first time the law showed a positive result in Gallup's survey. And the current Pollster.com estimate of public opinion, which aggregates multiple polls, shows health care reform's approval rating rising in recent months to a near deadlock (the spread is currently 46-43 against the law).

The White House hopes to continue that upward trend, especially as some of the new law's benefits kick in within weeks. Beginning Sept. 23, for instance, insurers will no longer be able to deny coverage to children with pre-existing conditions, and consumers will have the right to appeal insurance-company decisions to a third party. And Democratic leaders have also sent talking points to House members urging them to spend the next week in their districts highlighting the bill's popular new consumer protections for their constituents. Both are components of a coordinated Democratic strategy to promote the law in advance of the midterm elections, under the belief that the more voters hear about specific benefits in the bill, the more they'll support it.

The GOP is hardly giving up its fight, however. Last week, senior House Republicans, including minority leader John Boehner and GOP whip Eric Cantor, filed a petition that, if it collects signatures from a majority of House members, would force a House vote to repeal the law and replace it with a Republican package of far more modest health reforms. Meanwhile, conservatives are energized by the overwhelming passage of an Aug. 3 referendum in Missouri rejecting the new law's mandate that all Americans purchase health insurance (even though the vote has no real legal impact).

And Republican strategists insist reform is still far from popular — particularly because national polls don't do justice to opinion in the conservative battleground states and districts where this fall's key races will play out. "We haven't seen any signs that it has gotten more popular, particularly in swing districts," says Ken Spain, spokesman for the National Republican Congressional Committee. Republicans like Spain cite a recent Rasmussen poll showing that 59% of probable voters support repealing the measure (although Democrats consider Rasmussen's numbers unreliable and cite a mid-July Bloomberg poll that finds support for repeal at just 37%).

Even so, health care is not shaping up as a slam-dunk issue for the GOP. Although it's a key GOP talking point in races around the country, raising the issue also creates tricky questions for GOP candidates about their own precise views on how best to address voters' real concerns about the pre-Obama status quo. Which is why Republicans now face a strategic divide about whether to call for total repeal of the law, period — or whether to campaign on a more nuanced repeal-and-replace message, in which the GOP would offer alternative measures it claims would help solve the problem without imposing mandates for individuals and businesses.

The latter tack is the one Boehner and Cantor endorsed last week. But some conservatives believe repeal and replace is a misguided approach — one that will "muddy the waters" and amount to "betraying the repeal cause," in the words of the influential blogger Erick Erickson of redstate.com. Erickson and conservative groups like the Heritage Foundation's political-advocacy arm prefer an effort by Republican Representative Steve King of Iowa, who has filed his own petition to force a vote on repealing the bill without substituting any alternative law. (King says 170 House Republicans have signed the measure.)

Not that repealing health reform — which would require unimaginable Republican House and Senate majorities large enough to override a certain Obama veto — stands a chance before the next presidential inauguration anyway. Which is why, still, other Republicans are talking about choking off budget funding for key elements of the law should they win a House majority this fall.

When Republicans speak realistically, they talk about a longer time frame than the midterm elections. "I believe if you have a Republican Congress and a Republican President, in February or March of 2013 the bill will be repealed," former House Speaker Newt Gingrich said earlier this month. For now, however, most Republicans have a more limited ambition — namely to prove that health care can still be the huge political winner they were anticipating just a few months ago.