Strategists on how to handle healthcare in the election

No bumper sticker slogan is going to cut it this time.

They might both wish they could, but neither President Obama nor GOP presumptive nominee Mitt Romney are going to survive the general election without answering targeted questions about their healthcare visions.

The upcoming election promises to be a nail-biter because the nation is so polarized, so the former Massachusetts Governor and Obama must target their particular visions primarily at the votes in play – those who are independent, indifferent or undecided.

To achieve that, each politician needs to start sharpening a clear message about why his view of healthcare reform will benefit voters most and, at the same time, disarm the other’s strategy, according to several political strategists and analysts interviewed for this story.

And both candidates need to do so within the confines of a populace thus far given little explanation of the differences between Obamacare and Romneycare, save the fact that the former is nationwide while the latter is being exercised in a single state.

How either could parlay ACA ruling
Whether Obama gained credibility to put the pieces of his law in place as a result of the Supreme Court decision, or the backlash fiercely energized Romney supporters and contributors remains to be seen.

However much fire the Supreme Court decision fuels, a win is still a win, and it’s a positive for the president, said Henry Aaron, a senior fellow of economic studies at the Brookings Institution (pictured at left).

What with the economy and jobs the most oft-cited top issues on voters’ minds, such a victory in the healthcare realm is no guarantee of re-election. Obamacare as a whole polls poorly, though the individual aspects that have been activated are popular, even among some Republicans.

Obama’s biggest hurdle, perhaps, will be to overcome the fact that few Americans understand very much of the Affordable Care Act.

“You’re not going to explain the ins and outs of how health exchanges work to people in the next five months,” said Democratic strategist Peter Fenn, founder and president of Fenn Communications Group (pictured at right). “But you can explain to them what a plus it is to have their children on their insurance until age 26; to not be denied health insurance because of a pre-existing condition; to not have lifetime limits; to be able to count on being covered for health insurance; and the notion that you are expanding the pool to make it more cost-effective.”

The attention span of voters is short, so Fenn suggests that Obama focus on a short list, maybe three of those benefits.

In all campaigns, it is typically tough for an incumbent because the challenger just has to criticize and doesn’t have to suggest solutions. But this election might be different, at least when it comes to healthcare.

Romney’s and Obama’s health reform laws have similarities but diverge dramatically in that Romney’s is state-based, said John Graham, an economist and policy analyst at the Pacific Research Institute.

Romney hasn’t proposed major healthcare reform alternatives, Fenn said, and it’s “like nailing Jell-O to the wall figuring out where Romney stands.”

What Romney has said repeatedly is that health reform should be up to the states – an appealing angle for many on the political right. “Governor Romney has never stated that he would force every state to adopt Romneycare if he were president,” Graham said.

Considering that 26 states were part of the lawsuit against the Affordable Care Act, there was as little reason for Romney to deviate from the “state’s choice” tactic before the Supreme Court ruling as there was for Obama to launch a media blitzkrieg spotlighting the law’s accomplishments.

[Political Malpractice: Are politics extinguishing state insurance exchanges?]

“I think that Republican politicians — including Gov. Romney, Congress, and state governors and legislators — will have to give more definition to the reform with which they will replace Obamacare,” Graham added.

Time is nigh for honing messages
The Romney campaign has had to deflect his past health reform record in Massachusetts and its relationship with the current law, most often demonstrated by being less specific while proposing that many of these decisions should not be the domain of the federal government.

“Romney may need to transcend that,” said Thomas Miller, resident fellow at the American Enterprise Institute (pictured at right). “Just saying I’ll give it back to the states to figure out what to do probably isn’t going to get it done.”

For a deeper far-reaching strategy, the Romney campaign needs to sculpt the issue not just in the narrow sense of whom is at fault, Miller added, “but to speak a little bit more in a pro-patient and pro-consumer personalized manner.”

Romney has to say why he’s opposed to running a broader government program and how the ACA will only compound the problems instead of solving them.

Miller’s suggested strategy would also call on those who are a little better off financially to be more engaged in this process. Romney might suggest tools and policies to arm patients with the ability to insist that those who treat them do the best job possible, give them value for their money, and listen to them as a patient and consumer. And that to make sure they’re not listening just to “the folks who may have cut a deal in Washington or those who are getting paid for what remains on the table.”

[Political Malpractice: The chant is ‘ACA repeal’ but what could a GOP president actually do?]

At the same time, Romney has to talk about how better care is going to be delivered by physicians and other healthcare providers in a way that is more sensitive to the needs, concerns and interests of the patients, Miller added.

That’s an area in which Obama also needs to sharpen his focus.

Obama’s counterattack
For the president, the main message to target voters with is that the ACA, its accomplishments thus far, and the changes the law can bring in the near future are a boon to the middle-class.

“In the context of this campaign, it is going to be all about who will fight for middle-class families and stand up for them,” Democratic strategist Fenn said, before adding that the premise flows into issues of tax policy, educating children, and protecting senior citizens.

The president also needs to highlight that the ACA is based on Romneycare in Massachusetts and challenge Romney to explain why he has ostensibly reversed course. Six years later, his solution to dramatically reduce the number of uninsured through an individual mandate is very popular in Massachusetts.

“I think Romney is on extremely thin ice when it comes to criticizing,” the ACA, Fenn said. Additionally, Romney has recently called for just repealing the health reform law and has dropped the replace “because they have nothing to replace it with,” he added.

Likewise, Obama must tread carefully when comparing Obamacare to Romneycare, if only because of the economic effects Romneycare had on Massachusetts. Graham outlines those: “Premiums have gone up faster as a result of the law, costs are disguised by an increase in federal handouts to Massachusetts, and the state is planning to impose price controls on providers in order to contain costs.”

Might the same happen all across America if voters do not elect Romney to deliver on his promise of repealing the ACA?

The president has tried in various ways to show healthcare reform is a strength, and he has increased efforts since the Supreme Court ruling by spotlighting the advantages some citizens already enjoy.

Whereas Fenn suggested picking three such benefits, AEI’s Miller expects the Obama campaign to also be more forceful in attacks against Romney, particularly those that happen to make the ACA shine.

“He could be more aggressive and proud of this,” Miller said. “The president will talk more about what can be harmed or taken away from you if Romney is elected rather than defending how great things are going to be just over the horizon.”

[Q&A: How the S.C. Tea Parties took on the GOP over HIX – and won.]

He suggested as a messaging strategy for Obama to challenge Romney and the Republicans, saying, “We’ve already been out here trying to do something. It’s not perfect, and we’ve made a lot of progress. And you simply say eliminate that and go in reverse, but we can’t go back.” That reinforces some of what they’ve tried to do on their economic message.

Another potential strategy is to highlight the fact that the health reform law is already three years old alongside progress made thus far, and despite the Republican opposition. “The Supreme Court has said it is legal. The rest of the industry is moving along. Who are you to stand in the way of what’s coming ahead?” Miller added.

“This will continue to get better along the way because we simply must go forward. This will make it better overall, even though we don’t have everything worked out yet.”

A tax by any other name
There’s that Supreme Court decision again. In many ways, Obama is stuck with it.

Richard Epstein, a visiting scholar at the Manhattan Institute, thinks that Romney ought to focus on the financial burden that he believes the ACA will impose on the public.

“I think the basic Romney line ought to be that the president is willing to pile various financial burdens on individuals,” Epstein said, “whether they call them taxes or penalties.”

[See also: 10 things you didn’t know were in the ACA.]

Democrats and Republicans have had a tug of war over healthcare reform starting long before Obama’s presidency. Democrats want the debates to be contained within the four corners of healthcare policy, and “that is their political strength,” said Michael Franc, vice president of government studies at the Heritage Foundation (pictured at right).

Republicans want the healthcare debate to take into account other factors outside those walls, such as the national debt, overall spending, taxation, pro-life concerns, individual freedom, citizen’s relationship with the government and, of course, federal overreach.

“These issues tend to be where the Republicans are strongest and have the most ability to communicate with the electorate, especially independent voters,” Franc said. “If I were Romney, you can’t ignore all these concerns. Healthcare reform does not occur in a policy vacuum.”

Outside the four corners of health care, a lot of the themes that emerge are around who knows better when it comes to decision-making, the individual or the government, as well as how much freedom individuals should have to make such choices.

“These are the kinds of things that are going to become the entry-points back into the discussion about specific healthcare issues,” Franc said. “The bigger picture is going to be about some of these broad themes that get to the relationship of individuals to the government, and the effect of government policy on jobs and employment decisions, wages and tax burden.”

Voters ultimately want to have an alternative that they can wrap their arms around, mull it over, and think about which is most attractive.

“Because ACA was upheld, that ‘replace’ part of the discussion gets pushed to a backburner status,” Franc said, “until Congress can resolve once and for all what it’s going to do with respect to this law.”

The grand healthcare reform strategy for Republicans is to take over the Senate and win the White House in such a manner that they can use the budget reconciliation process to jettison most of the provisions of the ACA, especially all the vital organs that they need now.

[Political Malpractice: How politics distort Americans’ perception of health reform.]

“The mandate is clearly within the jurisdiction of the budget act. So it is possible with 50 votes in the Senate plus the vice president to take that out and anything that is related to it,” Franc said.

Should that wish comes true
Whereas Obama must explain the existing and future benefits of the ACA, the Republicans clearly need to come up with some kind of coherent and internally consistent alternative vision for what they would do.

“They can’t just run around and say ‘we want to repeal this and let the status quo go on,’ which in and of itself is dysfunctional,” Franc said.

To that end, either man may be well advised to choose carefully what he wishes.

“Candidate Romney is pretty clear he wants to stop the Affordable Care Act,” Brookings’ Aaron said, adding that if Romney was elected president and was successful in repealing or suspending implementation of the Affordable Care Act, “then every healthcare problem that evolves from then on is his. He will bear responsibility for it.”

Indeed, the same is already true for Obama.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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