Keeping Health Care Front and Center

When Democrats in the House passed the health care reform bill on March 21, they had high hopes that enactment of the legislation would relieve the political misery into which they had fallen. Bill Clinton promised that Barack Obama’s approval rating would rise ten percentage points if Congress passed a bill. At the least, Democrats like Congressman Dan Maffei declared that, with the issue settled, “Now we can move on.”

For their part, Republicans eagerly anticipated the opportunity of running next November against the unpopular bill and the people who passed it. Senator John Cornyn predicted that “This will be the defining issue in November 2010” and even the 2012 presidential election.

To say the least, the Democrats’ hopes have not been fulfilled. Obama’s approval rating showed no improvement (in some polls, it even dipped slightly), the approval ratings of Congress have continued going down, and a number of negative revelations have kept the bill a live issue. On the other hand, the health care bill remains unpopular and Republicans appear on track for significant gains in Congress, perhaps enough to retake control of one or both houses. However, it is also clear that Republicans will have to work to make Cornyn’s prediction come true.

The world does not stand still, and a number of other issues have already arisen to focus attention elsewhere. Terror plots, oil spills, and the relentless Iranian pursuit of the Bomb have all intruded. Between now and November, if the Democratic leadership has its way, Congress will be consumed with big legislation on financial reform, cap-and-trade, and immigration. The Value Added Tax has already made an appearance, and will doubtless remain on the stage as an issue if not yet a bill.

So how do Republicans keep attention on health care sufficient to ensure that it remains a pivotal issue in November?

The place to start is by understanding what it is that people do not like about Obamacare. The answer here can be reduced to two points: Americans do not like the substance-mandates, taxes, spending, regimentation of health care. And they do not like the process-the way the bill was rammed through in a purely partisan vote against the manifest preference of the nation by members of Congress who made unseemly deals and did not even really know what was in it.

Health care reform is potentially such a powerful issue because it not only featured these flaws but has come to symbolize them. It is now a metaphor for both bloated and grasping government and sleazy, irresponsible government.

As a result, it can be brought into the conversation any time either (or both) of those themes are present in other issues. Today, Democrats are trying to ram through a financial regulation bill that will extend costly bailouts indefinitely and create a whole new bureaucracy to regulate the economy-just like health care. Tomorrow, they will try to ram through a cap-and-trade bill that will massively expand government control of the economy on the basis of dodgy science that none of them understand-just like health care. The day after tomorrow (or perhaps the day after the election) they may try to ram through a VAT so that we can enjoy another aspect of European style socialism-just like health care. Health care should be woven into every ad, every mailing, and every speech as an example of the big-government recklessness and arrogance of Democrats in Washington, even when it is not the main point.

The combined themes of bad policy and bad process can be used more directly as well. Since March 21—starting almost immediately—there have been a series of revelations about the bill that have cast it in an even worse light. Some are related to new estimations of its future impact, as with the new estimates indicating that it will drive deficits and insurance premiums up, not down (as Republicans had always insisted). Others are related to hidden provisions and effects that are only now coming to light, such as the exemption of senior congressional staff and the way the law has forced companies like Verizon and Caterpillar to take massive write-downs and to indicate that they may be forced to drop coverage for company retirees. Republicans should plan to add to this drip, drip, drip by aggressively combing the 2,700 pages of legalese for more ticking time bombs.

When they have enough ammunition, they should begin firing once every week or two with a series of coordinated ads and media attacks that could go something like this: An NRCC ad shows Nancy Pelosi famously promising that once the bill is passed, we can find out what is in it. The ad then pinpoints the exemption of senior staff, the plight of Caterpillar, or the new deficit estimates. Then, when the issue has to do with provisions that were largely hidden from view, in every district or state with a Democratic “yes” incumbent running for reelection, the Republican challenger issues a press statement or runs an advertisement asking: “Congressman X, did you know about this? Did you know when you voted for it that the health bill exempted senior congressional staff/would force Caterpillar and Verizon to drop coverage for retirees/ cuts the amount that people can save in their flexible spending accounts/ etc.?” This strategy puts the “yes” Democrats in an obvious bind. They can either admit to voting for bad policy knowingly, or admit to voting for bad policy without knowing what was in the bill. It ties together one thing that people hate about the bill—that it was a bad bill—with the other thing they hate about it—that the process was highly flawed. And who can doubt that there will be enough ammunition to last the Republicans until November?

There are any number of issues and events that can divert attention away from health care between now and November. Republicans cannot ignore those issues, but they can keep health care front and center by using it as a metaphor for broader campaign themes, allowing them to tie it to other issues as they arise, and by creatively educating the public about the real character of Obamacare as it seeps out bit by bit.

Andrew E. Busch is Professor of Government at Claremont McKenna College and Ann and Herbert Vaughan Visiting Fellow at the James Madison Program in American Ideals and Institutions at Princeton University.