How Are Health Care Messages Playing With Americans?

The Obama administration continues to find itself on the defensive because of the rocky rollout of the Affordable Care Act. Meanwhile, Republicans took plenty of heat after their latest big push against the law, which resulted in a government shutdown. To get a handle on how each side has done in making their case to the American people, Steve Inskeep talks with Democratic pollster Anna Greenberg and Republican pollster Whit Ayres.

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STEVE INSKEEP, HOST:

Even as Sebelius testified, we brought two pollsters into our studios: one Republican, one Democrat. Both of these political pros spoke of Obamacare in intensely personal terms. Republican Whit Ayres spoke of someone unhappy at having to pay more for insurance. Democrat Anna Greenberg spoke of her brother getting insurance for the first time. She says the Obama administration has done a poor job selling the law for years.

ANNA GREENBERG: However, it does not concern me in the long run. Because at the end of the day, I believe personal experience and the trickle-down from personal experience will actually change people's views of the law. So, for instance, when someone's family member gets health insurance who didn't have it before, and everyone is relieved that person has health insurance, everybody in the family feels better about Obamacare.

So I concede that the message battle was lost early on. And it's been difficult since then to reclaim ground around message. But I actually think experience is going to matter a lot more.

INSKEEP: Isn't the message battle still being lost, because on the occasions when the president had a simple message, it's turning out not to match the complex reality. The president, for example, said if you want to keep your existing health plan, you can. That turned out to be an oversimplification, to say the least.

GREENBERG: I think in politics message means an overall framework for understanding why we're doing what we're doing and who we're trying to help. Details like you'll lose your bad insurance so you can get better insurance, which is basically what's happening with this conversation that's sort of been lost.

INSKEEP: There are requirements, yeah.

GREENBERG: Right, right. You're going to pay the same amount for much better insurance, but...

INSKEEP: Or pay a little more for better insurance.

GREENBERG: For much better - well, and in the end, if, for example, you don't have huge debt from unpaid medical bills, it actually ends up costing you less, even if you're paying a little bit more. This is the sausage-making. But I actually think, when you think about the overall framework and the overall value associated with the law, that is far more important to get that right.

WHIT AYRES: The message challenge for the White House has been and remains very significant. The president made a lot of promises about his healthcare plan that, according to our polling, most Americans never believed. They never believed that the plan would lower health insurance premiums for the average family by $2,500 a year, that the plan would not add one dime to the federal deficit.

The one promise they did believe is that if you like your current plan, you can keep it. And now they're finding out that not even that is true and they're feeling betrayed. I think the jury is still out about the individual impact on this law, but I think it's going to be negative.

INSKEEP: Whit Ayres, I want to summarize the Republican position on this law as essentially repeal it. They said repeal and replace. Republicans have not at all been clear about what they would like to do otherwise about healthcare. Now that the law is a reality, would you foresee any motivation for the Republican Party to take a different stance, to say we actually have these concrete proposals that we want to make to change the healthcare industry that's in the state it's in now?

AYRES: I think what you'll see is the Republican Party going after the parts of the law that are particularly unpopular and dismantling those parts, such as this requirement for comprehensive care that forces people to buy coverage they don't want, they don't need and they can't afford.

INSKEEP: But could you see leading congressional candidates or eventually presidential candidates saying I actually think there are issues that we need to fix in the healthcare system and this is the way that I want to go about it?

AYRES: They're not going to say it that way. They're going to say we need to dismantle the worst parts of this law now before they have an even more negative effect on the American people.

INSKEEP: Anna Greenberg?

GREENBERG: Look, the challenge for Republicans is that, first, they have a faction within the House of Representatives that only wants repeal and because of the structure of our constitution and our government, they are able to basically shut down meaningful conversations on the Republican side about an alternative. When you don't have a positive forward-looking vision about trying to improve people's lives, it is very, very difficult to win elections.

And in the area of healthcare, they don't have any ideas, except for changing parts of the law, to improve healthcare in this country.

INSKEEP: Would you say, as a pollster, that Republicans would need a positive message to go along with the negative one?

AYRES: Without question. Without question. People vote for things as well as vote against it and we have counseled all through this debate that Republicans need a positive vision for a better healthcare system.

INSKEEP: Let me throw out a proposition to you and you tell me if you agree or disagree with it or want to modify it in some way. We've had a really lousy public policy debate about this that has actually not explained to people very well what the problems of the system were or what the problems with the law are. Would you agree or disagree with that?

GREENBERG: I would agree with it. Part of the issue is that in the 2008 presidential campaign, even in the primary, there really was not a fulsome discussion of healthcare reform. It wasn't really a leading agenda item on the eve of the 2008 election. And so even going into the legislative debate and battle about it, we had not had that discussion.

AYRES: I'm not sure it's possible to explain the complexity of the health insurance industry and the healthcare system. But I also see that people understand the fundamental disagreements about this law.

INSKEEP: Whit Ayres and Anna Greenberg, thanks to you both for coming by.

AYRES: Thank you.

GREENBERG: Thank you.

INSKEEP: Republican and Democratic pollsters, here on MORNING EDITION from NPR News.

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