Health bill inspires conflicting visions

WASHINGTON - Democrats won a major legislative victory Sunday with the narrow House approval of a plan to overhaul the American health care system.

But will their legislative victory be a political triumph, or will passage of the largest new social program since Medicare become a political albatross around the necks of Democratic incumbents from Michigan to Texas?

Public opinion surveys reveal the depth of the Democrats' challenge. A new CNN/Opinion Research Corp. poll released Monday found that just 39 percent of American voters approve of the Democratic approach to health reform, while 59 percent disapprove.

"The decision by President Obama and the Democrat-led Congress to ignore the voters and ram their government takeover of health care down the throats of the American people will come at a steep political cost in November," predicted Rep. Pete Sessions, R-Texas, chairman of the National Republican Congressional Committee.

There's little doubt that Republicans have shaped the public relations battle over the past year. The challenge for Democrats is to change voters' perceptions of the legislation.

"Republicans have won the bumper-sticker war thus far," says independent pollster John Zogby. "But Democrats won the bill, and they have an advantage selling a fait accompli. Republicans should not lick their chops yet."

Here are some questions that are likely to predict which vision of health reform takes hold in the public consciousness:

- Will the new law be seen as the most important social policy achievement of the past half-century or a major step toward a government takeover of one-sixth of the U.S. economy?

Both sides will try to frame the significance of the health care overhaul. Democrats, working with their allies in the American Medical Association and seniors' groups, call it a major civil rights victory that gives patients and doctors more freedom. Republicans condemn it as a huge expansion of government.

- Will health reform end up costing us money or saving us money?

Democrats have some explaining to do here. The CNN poll found that four times as many Americans are convinced that their health care costs will increase rather than go down. Democrats can cite last week's report from the nonpartisan Congressional Budget Office that estimated a $143 billion savings over the next 10 years as a result of the Obama-backed plan. Republicans will focus on the new taxes contained in the bill, covering everything from tanning salons to high-income taxpayers.

- Do the benefits kick in quickly enough?

It'll be four years before consumers with pre-existing medical conditions are protected, for example. But a number of benefits will take effect before Election Day: tax credits for small employers, a reduction in the so-called "doughnut hole" in Medicare drug coverage, a ban on lifetime limits in insurance coverage, creation of a high-risk insurance pool for individuals with pre-existing conditions and an end to insurance company cancellations of policies because consumers get sick.

- Will Americans revolt against the bill's new mandates?

Adults will be required to buy health insurance. Companies with more than 50 employees will be required to provide insurance for workers or pay a fine. Will voters see these as onerous federal requirements or acceptable contributions to a system that will insure more than 40 million additional Americans?

- Did the opposition exaggerate or fabricate its case against health care reform?

For the past year, Republicans have talked about "death panels" and evoked the specter of Stalinism and even Nazism as they tried to thwart Obama's health care agenda. From this point on, you'll hear Democrats talking about "death panels" - at least to remind you that the package likely to become law is not the same thing that was demonized by conservatives and insurance companies in the heat of the past year's battle.

- Is the reform law constitutional?

Republicans may have lost the legislative war, but they have the Supreme Court as a last line of defense against Obama's plans. GOP lawmakers say that the reform plan is unconstitutional because the federal government requires individuals to buy health insurance. The president may yet rue the day he criticized the Supreme Court at his 2010 State of the Union address.

U.S. Sen. Jim DeMint, R-S.C., said he would introduce legislation to repeal the health care bill today, immediately after Obama signs the measure into law.

"This bill is unconstitutional, and it cannot be fixed," DeMint said. "It must be repealed. The battle for health care freedom is not over."

DeMint said five other Republican senators had signed on to co-sponsor his legislation as of Monday: Sens. Bob Bennett of Utah, Kay Bailey Hutchison of Texas, David Vitter of Louisiana and James Risch and Mike Crapo of Idaho.

"Unless this trillion-dollar assault on our freedoms is repealed, it will force Americans to purchase Washington-approved health plans or face stiff penalties. It will fund abortions, raise taxes and insurance premiums, while reducing health care choices and quality," DeMint said.

House Majority Whip Jim Clyburn, a Columbia Democrat who played a key role in ensuring passage of the health care measure, made a word play on DeMint's name in criticizing the senator's plans.

"I think a senator would have to be rather demented to go out to the American public and say he's going to vote for a (repeal) bill that will make it legal once again for insurance companies to deny children coverage if they have diabetes," Clyburn said.