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Healthy Respect

Why Democrats should stop running from their greatest achievement.

Russ Feingold is running for his political life. But he is not running from health care reform. Feingold, a three-term senator from Wisconsin, who has been trailing in the polls for weeks, recently unveiled an advertisement that puts his support for health care reform—and his opponent’s pledge to repeal it—front and center. The ad features a series of people touting the protections in the Affordable Care Act. One mentions the guarantee of coverage for children with pre-existing conditions. Another talks about the government’s expanded authority to regulate insurance-premium rates.

It’s the kind of TV spot many reform proponents had in mind back in March, when President Obama signed the Affordable Care Act into law. But Feingold’s ads are pretty unusual. Most Democrats aren’t trying to talk about health care reform this cycle. If anything, they’re trying not to talk about it. The few exceptions to that rule include Democrats who voted against the Affordable Care Act and now brag about that decision.

This silence might seem like a smart call. Polls consistently show that the public is ambivalent about the Affordable Care Act; the percentage of people who disapprove of the law is typically a few points higher than the percentage of those who approve of it, although the margin varies wildly depending on the poll. And, particularly in the most conservative districts, some voters might truly be angry about health care reform—enough to change their minds about whom to support in November. But Democrats on the whole should pay close attention to what Feingold is saying about health care.

The main reason for hope is the polls—yes, the very same polls that suggest the Affordable Care Act is so unpopular. Those “topline” findings, as the pollsters call them, actually mask a much more complicated set of feelings. It turns out that a large portion of the respondents who disapprove of health care reform are upset that reform didn’t go far enough—in other words, that government won’t do more to expand coverage, protect consumers, and drive down the price of medical care. Some of these people (it’s hard to know how many) would prefer to strengthen reform by building on it—adding a public option, for example, or turning it into a single-payer system. Whatever their disappointment with Democrats for not doing these things in the first place, they’re not interested in repeal.

The toplines also obscure another reality: People may not like the Affordable Care Act, per se, but they like nearly all of its component parts, in some cases by huge margins. Polls by the Kaiser Family Foundation, in particular, have found that even among self-described Republicans, majorities approve of ideas like guaranteeing coverage for people with pre-existing conditions. One reason those sentiments don’t translate into broader support is that opponents successfully misled the public about what’s actually in the bill. A majority of senior citizens, for example, either think the Affordable Care Act has death panels (that is, boards to make life-or-death decisions about treatment) or aren’t sure about it. The less Democrats say about the Affordable Care Act, the more Republicans will convince voters that claims like these are true.

Of course, sometimes opposition to the Affordable Care Act has nothing whatsoever to do with health care reform. Plenty of voters are simply unhappy with President Obama and the Democrats because they haven’t done more to revive the economy. To them, the Affordable Care Act is symptomatic of an administration that has lost touch with the average American. But the first set of consumer protections in the Affordable Care Act, which are just now going into effect, include provisions that protect individuals from abusive insurance company practices. Touting those can bolster the Democrats’ populist bona fides—while revealing how unappealing, or simply nonexistent, Republican ideas for health care are. Democrat Jack Conway, who is running for Senate against Republican Rand Paul in Kentucky, did just that in an interview with CBS News when he asked, “Does Rand Paul want to repeal all of that? What would he replace it with?”

To be clear, a strong pitch for health care reform isn’t going to scramble the election outcome at such a late date-although Democrats could certainly use every marginal advantage they can get. But taking a more aggressive stand on health care reform isn’t just about winning a few more seats. It’s also about fighting the political battles to come. It will be many years before the Affordable Care Act’s biggest changes come into view—an interval during which Republicans will do their best to hobble the new law, even if they can’t get it off the books. And while it will be a few months before that debate begins in earnest, the time to prepare for it is now.

This piece will run in the October 28, 2010, issue of the magazine. 

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This version is corrected from an earlier version, which inaccurately claimed that Jack Conway had made his comment about Rand Paul's repeal position on CBS News's "Face the Nation." He made those comments in an interview with CBS News. We regret the error.