Now that the Supreme Court has ruled on the constitutionality of the Affordable Care Act (ACA), the playing field is set for the 2012 elections. It is unlikely that any outside event will alter the health policy environment in which candidates for president, Congress, and governor will be running. So what should we look for over the 17 weeks remaining between now and November 6?
Who is talking about healthcare? So far, Republicans have been far more interested in discussing “Obamacare” than Democrats. As a result, most agree that healthcare issues have been successfully framed by the GOP, to the detriment of Democrats. It is worth remembering that the ACA passed and was signed into law without the support of a single elected Republican. Democrats own this issue.
For their part, Democrats have largely been left to defend the individual mandate, for example, rather than promote the increased availability of health insurance for those with pre-existing conditions or kids just out of college. Will the court's decision change that calculus? Will Democrats feature their support for health reform in campaign ads? Or will they instead suggest that the court has “endorsed” the law and it is time to move on? Will Republicans lead with their opposition to the ACA? Or will GOP candidates focus primarily – or exclusively – on the economy?
Where are they talking about it? The presidential election is, of course, a series of state-by-state contests to win the requisite 270 Electoral College votes. Analysts list between seven and 10 states as up for grabs. How will Florida Republican Gov. Rick Scott's vocal opposition to Obama's health policy influence campaign decisions in that most important swing state of all? What should the Obama campaign do in Ohio, where the Republican challenger to Sen. Sherrod Brown has made Brown's support for “Obamacare” a central part of the argument that Brown should be replaced? There are similar questions in other key states, like Colorado, Iowa, Nevada, New Hampshire, and Virginia.
In races for the US Senate, Democrats must defend 23 of the 33 seats at stake in 2012. That fact alone would be enough to put Democrats' 51-to-49 working majority at risk. But in places like Montana and Missouri, states where President Barack Obama and his healthcare bill are not popular, incumbent Democrats face very difficult challenges. In the House, where the GOP has a majority, Republican polling continues to show Democrats who supported passage of the ACA are vulnerable.
Finally, believe it or not, it will be worth watching at least some of the upcoming Republican and Democratic nominating conventions. These events, arriving on the heels of the Summer Olympic Games, will lay out the themes and messages both parties and candidates believe will work best for them. How much do they discuss healthcare in primetime? What are Obama, Gov. Mitt Romney, and their surrogates saying about it? Are Democrats launching a robust defense of the ACA, or is the president acknowledging the court's decision and shifting to other issues? Are Republicans emphasizing repealing “Obamacare,” or is Romney sticking exclusively to the President's stewardship of the economy?
What is said in 2012 will have much to do with what happens in 2013. So it is worth paying attention.
Al Jackson is head of Chandler Chicco in Washington DC.