1. Health

In August, Republicans and Democrats prepare fresh fight over Obamacare

Opponents of Obamacare try to squeeze in to a packed August 2009 town hall meeting featuring U.S. Rep. Kathy Castor, D -Tampa, at the Children’s Board of Hillsborough County.
Opponents of Obamacare try to squeeze in to a packed August 2009 town hall meeting featuring U.S. Rep. Kathy Castor, D -Tampa, at the Children’s Board of Hillsborough County.
Published Feb. 11, 2014

WASHINGTON — A playbook handed to House Republicans on their way home for the August recess contains instructions for an "Obamacare media tour."

Find three businesses that cut jobs or limited growth because of the health care law and organize events with radio and TV outlets. "Make sure the participants will be 100% on message. Note: While they do not have to be Republicans, they need to be able to discuss the negative effects of Obamacare on their employees."

But for every move the Republicans make — every town hall, job fair, community cookout, fundraiser and Obamacare bashing session — Democrats will be waiting.

"When Republicans get home, they should grab a glass of lemonade and buckle up," said Brad Woodhouse, president of Americans United for Change, which is posting the August schedules of GOP lawmakers on a website and encouraging voters to show up and tell them to leave the health care law alone. "It's going to be a rocky month if we have anything to say about it."

Four years after contentious August town halls marked the opening salvos in the war over President Barack Obama's signature legislative accomplishment and solidified the rise of the tea party, a new summer of discord has arrived.

By air, with dueling campaign-style TV ads. On the ground, with street-corner-to-town-hall fights over millions of Americans who are key to the most expansive health care reform in generations.

The targets are women, seniors, young people and millions of people without insurance, who could get insurance in new "exchanges" that are a centerpiece of the law. Enrollment begins Oct. 1, so both sides are marshalling forces to get out their messages.

If it sounds like a massive do-over, an attempt to re-litigate the legislation, it is. Republicans were unanimously against the bill from the start and want to turn reports of higher premiums and skittish employers into a public backlash that accomplishes what they have failed to do: Kill the law.

"No entitlement that has ever been implemented has ever been unwound," said Sen. Ted Cruz, R-Texas, calling the recess a critical last stand. "It's going to have to be a grassroots movement to succeed. No politician in Washington can win this fight."

Congress' final week before a month off got things rolling, with a group of Republican senators including Florida's Marco Rubio threatening to shut down the government if the law is not stopped. On Friday, House Republicans held their 40th vote to repeal Obamacare.

The president headed to Capitol Hill on Wednesday to calm Democrats' worries about the implementation and political consequences of the law.

"You're on the right side of history," he told them.

• • •

The Affordable Care Act was signed into law in 2010 and withstood a Supreme Court challenge in 2012. But even as parts have gone into effect — including popular provisions such as allowing people under 26 to remain on their parents' insurance — it remains unpopular.

A June poll by the Kaiser Family Foundation found 35 percent American approval versus 43 percent disapproval, though a segment of the latter group thinks the law does not go far enough. Many Americans are unsure if the law is even in effect.

Democrats blame an onslaught of negative TV ads — $500 million, nearly 5-to-1 against health reform, since 2009 — that were often misleading or false. (See, Subject: health care.) But the Obama administration has been criticized for a poor sales job.

"They have been entirely deficient up until about six months ago," said Sen. Bill Nelson, D-Fla. "All the noise was coming from the other side. We have to ramp it up as to the benefits."

Obama returned to the issue in a recent speech, standing in the White House with people who have received rebate checks, one of the law's benefits that Nelson says has not been highlighted. Obama pointed to projected premium decreases in states that have set up health care marketplaces, including New York, where 50 percent drops are possible.

The news is not universally upbeat.

In Florida, where Republican lawmakers refused to participate in setting up the exchanges, individual rates are projected to increase an average of 35 percent, though tax credits people would get to offset any increase are not taken into account. Ohio officials, who also declined to set up a state-run exchange, said rates could go up 41 percent for individual buyers. As in Florida, critics argued the numbers were based on inaccurate assumptions.

Still, Obama handed detractors an opening by delaying for a year implementation of a provision requiring most businesses to provide coverage or face fines. The individual requirement for insurance will go into effect in 2014 as planned.

"If President Obama is willing to grant a waiver to giant corporations, why won't he grant the same waiver to hard-working American families?" Cruz said Thursday at a news conference ouside the Capitol where opponents outlined their plans to attack the law (as well as immigration reform and the IRS).

Jenny Beth Martin, co-founder of Tea Party Patriots, said activists will spend August holding town halls across the country and "street rallies," where people wave signs to passersby. Tea party members will attend meetings held by members of Congress, though lawmakers in both parties are eschewing the traditional format for safer "tele-town halls" conducted over the phone.

Undeterred, the conservative group Heritage Action for America is hosting "defund Obamacare" town halls throughout the month with stops in nine cities, including Tampa on Aug. 21. The meeting will be hosted by former Sen. Jim DeMint of South Carolina.

• • •

Town halls in 2009 became ground zero for the fight over health care reform, with angry crowds showing up to denounce the effort. Rep. Kathy Castor, a Tampa Democrat, made national news becoming overwhelmed by a large group shouting "Tyranny! Tyranny! Tyranny!" and pushing and shoving.

Castor is not holding a town hall this month but plans on small business forums to explain the available tax credits and working with community health centers and nonprofits to publicize the law.

Rep. Rich Nugent, R-Spring Hill, will be talking up flaws of the bill. But Nugent said the Republican assault — punctuated by Friday's 40th repeal vote in the House — is also flawed. "When you start talking about replacing something, you need to come up with ideas. That's part of the problem."

Democrats will try to seize on that as they go after Republicans. Caught off guard in 2009, they have vowed to not let history repeat itself.

Americans United for Change and a group called Protect Your Care have hired staffers in 10 states, including Florida, Texas and North Carolina to coordinate weekly events promoting the law and to conduct "rapid response" to Republican claims.

Organizing for Action, the spin-off group from Obama's campaign machine, has begun grass-roots organizing, asking volunteers to shower communities with fliers promoting the law — a tactic the group calls "blizzarding."

On Sunday — Obama's 52nd birthday — OFA will hold events across Florida as part of an "Action August" campaign.

The group is taking the fight to TV, having aired two ads already on national cable and Bravo and Lifetime. The latest ad features a girl who had open heart surgery shortly being born. Her mother talks about how before Obamacare insurers put lifetime caps on coverage and says, "Zoe was halfway to her cap before her first birthday."

Meantime, states with health care exchanges are using catchy TV ads to encourage participation. In Oregon, a girl in a red dress with a guitar stands in a field as a cast of people carry painted landscapes. "We live long in Oregon. Long live our Oregon spirit," she sings in the ad that is part of a $10 million campaign for the exchange called Cover Oregon.

In all, spending on the advertising and awareness campaigns will top $684 million, according to data the Associated Press complied from federal and state sources. The goal is to reach the poor, the young or people who have had to give up insurance due to cost.

On the other side, Americans for Prosperity, a conservative group funded by the billionaire Koch brothers, is spending more than $1 million on anti-Obamacare spots in Ohio and Virginia, key election battlegrounds. A new ad launched last week features a woman doctor who states, "Obamacare has me worried."

FreedomWorks, which helped build the tea party, has turned attention to young people. Their participation is vital to the overall success of Obamacare because they are healthier, easing the strain on the health care system. Obamacare "draft" cards are being distributed so people can burn them in protest (and hopefully post video and pictures on social media).

"We're trying to make it socially acceptable to skip the exchange and pay the fine," said Dean Clancy, vice president of public policy at FreedomWorks. "The law permits that and for many that's the financially sensible course. We hope that in educating folks, we'll help hasten the collapse of the exchanges."

Contact Alex Leary at