Little has changed since President Obama signed his top-priority health care reforms into law 12 months ago: The health care industry remains essentially unchanged, public opinion of the law remains divided and Obama is still fighting a fierce partisan battle — this time to ensure implementation of the reforms. The president’s difficulty publicizing the positive effects of his defining legislation is rooted in the law’s sluggish implementation, according to policy analysts. The bill won’t be fully implemented until 2014.
“Most people don’t spend their time obsessing about details of a law that essentially hasn’t happened yet,” said Joseph Antos, health care adviser for the Congressional Budget Office. “That is Obama’s problem. It essentially hasn’t happened yet.”
Opinion polls underscore that many Americans remain confused about what’s contained within the wonky 2,000-page law, and Obama admitted after the November midterm elections in which Democrats took a beating that his administration hadn’t done a stellar job of explaining it.
“Given how much stuff was coming at us, we probably spent much more time trying to get the policy right than trying to get the politics right,” Obama said. “And I think anybody who’s occupied this office has to remember that success is determined by an intersection in policy and politics and that you can’t be neglecting of marketing and [public relations] and public opinion.”
One year after passage, a Gallup Poll found that 46 percent of voters support the bill compared to 44 percent who oppose it. A CNN poll found stronger opposition — roughly 59 percent — including 13 percent who said the law doesn’t go far enough. The number of supporters was virtually unchanged from a year ago, when 39 percent backed it, to 37 percent today.
“[The law is] clearly not helping Obama,” Antos said. “When you look at the opinion polls, the trend is completely flat.”
The White House has tried to quash confusion over the bill’s intricacies through costly public-relations campaigns, which the administration ramped up this week to mark the law’s first birthday.
Meanwhile, opponents of the law are effectively using the post-passage lull to undercut its pending implementation.
“The bill had a built-in vulnerability that was quite serious,” said Robert Sprinkle, a professor of health policies at the University of Maryland. “Many of the potentially most helpful, most appreciated aspects of the bill are delayed until 2014, which means a lot people are still uncertain as to whether this bill is advantageous — so they are easily persuaded [otherwise].”
Twenty-six states have legally challenged parts of the law as unconstitutional, and judges’ rulings are nearly evenly divided for and against the law. Both sides agree it will be left to the U.S. Supreme Court to decide the law’s constitutionality.
In the meantime, congressional Republicans are trying to cut funding for provisions scheduled for more immediate implementation.
Apart from a judicial ruling, little will secure the future of Obama’s health care law, said Thomas Miller, former senior health economist for the House Joint Economic Committee.
“The problem is not the message — we have had all kinds of message saturation,” he said. “The jury’s out on this one. … We’re still in that in-between state where the battle is on.”
