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RENEE MONTAGNE, host:

And when Democrats passed their health overhaul bill back in March, they hailed it as the biggest domestic achievement since Medicare. Seven months later, most of the noise about the new law on the campaign trail is coming from opponents.

Here's NPR's Julie Rovner with a look at how Democrats are handling the subject of health care in this elections season.

JULIE ROVNER: In much of the country, all you have to do is flip on your TV to notice one change between this year's campaigns and many previous mid-term elections. That's the huge number of ads from outside groups, rather than from candidates themselves. And many of those groups are trying to feed on the unpopularity of the new health law.

Revere America, for example, headed by former New York Republican governor George Pataki, has been running this ad in districts of Democrats who voted for the law.

(Soundbite of commercial)

Unidentified Man #1 (Announcer): ...costs will go up, care will go down. Longer waits in doctor's offices. Your right to keep your own doctor may be taken away. It's a plan we didn't want and don't need. But she voted for it anyway.

ROVNER: But in most states, there's one group saying surprisingly little about the new law - Democratic candidates running for the U.S. House and Senate. Geoff Garin is a Democratic pollster and president of Hart Research Associates.

Mr. GEOFF GARIN (Hart Research Associates): The controversy over the health care reform law has made a lot of Democrats nervous and gun shy, and probably more than they ought to be. There are some people who don't even want to raise the topic of health care for fear of getting into a debate over the health care law.

ROVNER: But Garin says there are some elements that are highly popular and that voters don't actually want to see repealed.

GARIN: The provisions relating to preexisting conditions or coverage of preventive care, or the additional help for seniors with their prescription coverage. Those are good debates to be in if you're a Democrat, over those kinds of issues.

ROVNER: And at least some Democrats are taking up the cause. Wisconsin Senator Russ Feingold, for example, has been running this ad. He's locked in a closer-than-expected race for re-election against Republican Ron Johnson.

(Soundbite of commercial)

Unidentified Woman #1 (Announcer): Russ fought to stop insurance companies from denying Wisconsin children health care due to preexisting conditions.

Unidentified Man #2 (Announcer): Mr. Johnson would put insurance companies back in control...

Unidentified Woman #2 (Announcer): ...letting them raise premiums and increase our costs whenever they want.

ROVNER: Another embattled Democrat, North Dakota Congressman Earl Pomeroy, is also focusing on the health law, but from a slightly different perspective.

(Soundbite of commercial)

Unidentified Man #3 (Announcer): North Dakota doctors, nurses and hospitals all praise Earl Pomperoy because he listened, and then made sure the health care bill protected North Dakota, improved Medicare, and kept our rural hospitals open.

ROVNER: Long Island Democratic Congressman Steve Israel, meanwhile, is taking a different tack altogether; casting the health issue as part of a bigger us-versus-them theme. His ad simultaneously takes on big health insurance companies and BP.

Congressman STEVE ISRAEL (New York, Democrat): Up there, record profits ahead of patients. Over there, a tragic mess that they created.

ROVNER: What Israel is doing is what more Democrats should be doing, says Ethan Rome. He's a longtime Democratic strategist who now heads the group Health Care for America Now.

Mr. ETHAN ROME (Health Care for America Now): It's not about one issue. It's about which side are you on? Are you for working families or are you for the big corporations?

ROVNER: But while most Democrats may not be featuring the health law in their television ads, Rome says it's a mistake to think it's not a part of their ongoing campaigns.

Mr. ROME: Folks are talking about health care every day on the stump. They're talking about health care with neighbors, at town halls; in their campaign, in all sorts of different ways.

ROVNER: Still, Democratic pollster Garin worries that Democrats may be shying away from an issue where they've long held the political high ground.

Mr. GARIN: Health care is an important issue before the voters and it seems mistaken for Democrats to simply vacate the field on all of this.

ROVNER: Garin also says some Democrats may have an opening with Republicans who've overplayed the health card - by calling for full repeal of the new law; the popular as well as the unpopular elements it contains.

Julie Rovner, NPR News, Washington.

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