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Health care debate has trust, politics themes, too

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WASHINGTON (AP) - For months, the talk was all about computer code. About response times. About glitches and bugs.

People who didn't know a URL from an http were blithely expounding on software snags and web design, thanks to the clunky launch of, the insurance marketplace for the government's big health care overhaul.

With the website improving and tech chatter settling down, the conversation about the Affordable Care Act, or "Obamacare," is turning in other directions.

It's about trust. It's about big government. It's about politics. And, oh yeah, it's about your health care, too.


Or an agenda? The debate over President Barack Obama's health care law has gradually morphed into a broader discussion about whether he is to be trusted. It's a critical question for Obama, who could always rely on strong ratings on his leadership and personal qualities, even if people did not agree with his policies.

It turned out that the confidence he exuded prior to the disastrous launch of the health care exchanges was misplaced. Then came revelations that, despite Obama's assurances that people could keep their plans if they liked them, millions of Americans faced insurance policy cancellations. Now Republicans are highlighting questions about whether people will be able to keep their doctors.

Obama has tried to head off the cancellations by giving insurance companies more flexibility. But Republicans have been only too happy to pound him for broken promises, and to insist that he knew all along what would happen.

The debate has taken a toll on the president's credibility. A Quinnipiac University survey of registered voters last month found the share of Americans who thought Obama was honest and trustworthy had fallen 10 percentage points over the fall, to just 44 percent.

The health care launch "turned out to have moral dimensions as well as policy dimensions," says Robert Blendon, a Harvard professor of health policy and political analysis. Obama "really has to restore confidence in himself. He's got an agenda for the rest of his term here."

And Republicans will be sure to ask at every turn why Americans should take the president at his word on immigration reform or budget policy or any other big issue if he led them astray on health care.



The struggle over Obama's health care law has reinvigorated a debate that's been going on for centuries and never seems to get settled: the core question of what government should or shouldn't do for people, and how it should spend their money.

For years now, Republicans have displayed remarkable message discipline in zinging the Obama White House for creating a "government-centered health care delivery system," arguing that the matter would be better left largely to private forces. The failed website sign-up launch generated a whole new round of head shaking about government overreach.

Rep. Darrell Issa, the California Republican who misses no opportunity to investigate perceived shortcomings in the overhaul, devoted a hearing last week to the "limitations of Big Government" when it comes to health care.

"By its very design, the federal government may never be efficient or effective or innovative enough to carry out big initiatives like Obamacare, nor should it be," he says.

It's the antithesis of Obama's yes-we-can philosophy that government should step in to ensure all Americans have the opportunity to thrive and succeed.

White House chief of staff Denis McDonough sees "a strange case of nostalgia" breaking out among Republicans for the greater flexibility of the old health care system _ one that he says "covered too few people in a maddeningly inefficient and often heartbreaking and ultimately very expensive way."



The law is more than three years old, but there's nothing past-tense about the politics. Both parties are expecting an epic dust-up over the law in next year's congressional elections and are already gearing up for it.

"Obamacare is the center of the universe as it relates to 2014 because so many Republicans believe it is the perfect vehicle to argue a whole host of issues," says GOP strategist Kevin Madden. Matters of trust, competence, big government and more will be framed by that one topic.

Whether Democratic candidates want to talk about the health care law or not, party strategists are preparing a full-throated case supporting it. They're talking up the benefits that Americans seem to like, or will, once they know them, and assembling examples of people helped by the changes to counter the tales of horror coming from the GOP.

It's a necessarily defensive posture, but an aggressive one, and no doubt meant to buck up the courage of Democratic lawmakers who rallied behind the legislation when it passed only to feel burned by the administration's fumbles now.

"This is going to be a sustained conversation," says Mo Elleithee, the Democratic National Committee's communications director. "This is going to be a good time to highlight the differences between the two sides."

And, he dares to hope, "the politics of this will work out as people begin to understand and see the benefits up close and personally."

Should that happen, Democrats may have some success painting Republicans as obstructionists who never wanted the law to work and were willing to shut the government down to advance their anti-Obamacare campaign. That's why Elleithee says: "Ted Cruz is my best friend right now."

It will take more than a rebound of the website, though, for everything to be set right with the law and for critics like Cruz, the Texas senator, to be quieted. Plenty of touchy moments are ahead as delayed provisions of the law come into effect and as more Americans see an impact, for better or worse, on their plans, premiums and choices next year.

"It's going to be a very tough hill to climb," Madden says of Obamacare's architects. Or so Republicans hope.



For years, the debate over the health care law was largely theoretical, with many provisions not taking effect until 2014.

Now, reality is setting in on a matter that is intensely personal for every American.

Wendell Potter, a former insurance company executive turned critic of the industry, says Republicans got a head start in the debate by generating fear about what might occur under the law.

Once the new health plans are in place next year, "the world changes," says Potter. "Some of those scare tactics don't work anymore."

Each side is aggressively pushing out real-life stories to bolster its arguments about the benefits or perils of the new law: the cancer patient whose surgery was canceled after her plan was canceled; the diabetic who was finally able to find coverage after being laid off last summer.

The dueling anecdotes could be important in shaping public opinion about the law since not everyone has a personal story to tell about it.

"Most Americans are not directly affected a lot by this law, and yet they're going to have very strong opinions about whether it's a good thing or a bad thing for the country," says Blendon. "That's where the spin gets to be very important."


Associated Press writer Calvin Woodward contributed to this report.


Follow Nancy Benac on Twitter at

(Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)

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