DOYLESTOWN, Pa. — Erika Losse is precisely the kind of person President Obama’s signature health care law is intended to help. She has no health insurance. She relies on her mother to buy her a yearly checkup as a Christmas gift, and she pays out of her own pocket for the rest of her medical care, including $1,250 for a recent ultrasound.
But Ms. Losse, 33, a part-time worker at a bagel shop, is no fan of the law, which will require millions of uninsured Americanslike herself to get health coverage by 2014. Never mind that Ms. Losse, who makes less than $35,000 a year, would probably qualify for subsidized insurance under the law.
“I’m positive I can’t afford it,” she said.
A Supreme Court ruling on the constitutionality of the health care law is expected any day now, but even if the Obama administration wins in the nation’s highest court, most evidence suggests it has lost miserably in the court of public opinion. National polls have consistently found the health care law has far more enemies than friends, including a recent New York Times/CBS News poll that found more than two-thirds of Americans hope the court will overturn some or all of it.
“The Democrats have done a very poor job of selling the program,” said Gary Schiff, 65, a retired teacher and businessman here. “All you hear about it now is the Republicans saying what’s wrong with it: that it’s socialism, that it’s going to bankrupt the country. I’ll give them credit; they’re great at framing the debate.”
That success may stem in large part from more than $200 million in advertising spending by an array of conservative groups, from the U.S. Chamber of Commerce ($27 million) to Karl Rove’s Crossroads GPS ($18 million), which includes the billionaire Sheldon Adelson among its donors, and the American Action Network ($9 million), founded by Fred V. Malek, an investor and prominent Republican fund-raiser.
In all, about $235 million has been spent on ads attacking the law since its passage in March 2010, according to a recent survey by Kantar Media’s Campaign Media Analysis Group. Only $69 million has been spent on advertising supporting it. Just $700,000 of that comes from the Obama campaign, and none of its ads mentioning the law are currently being broadcast, said Elizabeth Wilner, vice president of the Campaign Media Analysis Group. “It explains, in a nutshell, why polling shows attitudes about the law to be at best mixed,” she said.
On the other side, the 60 Plus Association, a conservative lobbying group for older Americans, has targeted Democratic senators up for re-election with about $10 million in ads warning that under the law, “unaccountable bureaucrats” will be able to “ration care.”
A number of Republican candidates have also condemned the law in campaign ads. Ron Gould, who is running in Arizona’s Fourth Congressional District, released an ad this month in which he blasts a copy of the law to bits with a shotgun.
In contrast, most advertising spending in support of the law has come from the Department of Health and Human Services. Appearing mostly on national and cable networks, the agency’s ads are bland, explaining aspects of the law.
“Did you know with your health insurance, you may now have some preventive benefits with no co-pays or out-of-pocket costs?” one asks.
Here in the suburbs of Philadelphia, which, according to the Campaign Media Analysis Group, is one of the top five media markets for ad spending against the health care law, it is apparent how such messaging is playing out. (The other top markets are Orlando, Fla.; Tampa, Fla.; Pittsburgh; and Denver, all in swing states.) In interviews with about two dozen residents who were mostly opposed to the law, certain worries, resentments and dark predictions about it came up time and again.
Nearly everyone said the nation could not afford the law’s goal of insuring about 30 million Americans, mostly through a vast expansion of the Medicaid program and federal subsidies to help others who cannot afford to buy coverage on their own. A striking number of people also said the law would limit patient choices and lead to rationing of care — a fear that has been stoked by conservative lawmakers, talk-radio hosts and commentators on networks like Fox, in addition to the political action committees that have run ads attacking the law.
In Doylestown, Richard Tems, a businessman and member of the Bucks County Republican Committee, echoed the national messaging against the law as he ticked off reasons it was a bad idea. Mr. Tems, 64, said the hip replacement surgery he had three years ago might not have been possible under the law, which he believes will lead to rationing and, ultimately, a system of socialized medicine.
“I got to pick my surgeon, I got to pick my hospital, I got to pick the day I was getting it, I got to pick the kind of hip I wanted,” he said. “All of that goes away. If you look at any nationalized health program, whether it’s Canada’s or England’s, they ration everything.”
Mr. Tems also offered grim predictions about what might transpire under the law — citing, for example, the death in 2009 of the actress Natasha Richardson, who suffered a brain injury while skiing in Canada. Repeating what some conservative commentators have said, he theorized that Ms. Richardson died because she did not have fast access to the care she needed under Canada’s government-run health care system.
In Langhorne, Dr. Richard Leshner, a cardiologist, said he feared that accountable care organizations — groups of doctors and hospitals, encouraged under the law, which are supposed to work together to coordinate patients’ care and thus cut costs — would strip individual doctors of their autonomy. “And patients will lose their advocates,” he said.
Several of those interviewed mocked the tax penalties that uninsured people and certain employers who do not provide health insurance would face. Tom Hebel, who employs 65 people at his gardening store in Doylestown, said paying the penalty could end up being far cheaper than complying with the law.
Mr. Hebel, 56, also said he worried the law would put taxpayers in the position of footing the bill for overly generous insurance plans for people who could not afford to buy their own.
“It creates a sense of entitlement and expectation,” he said. “You want to be on birth control? Buy your own damn birth control. You want to get laser eye surgery? Pay for it yourself.”
For others, the anticipated cost of adding millions of people to the ranks of the insured is simply untenable. Jeff Brahin, a lawyer in Doylestown, said he could not stomach supporting the law even though he liked the idea of insurance for everyone.
“It’s going to cost a fortune, and we already have a gigantic deficit,” said Mr. Brahin, 53.
Back in Langhorne, Cindy McMahon and Debbie Zimmerman, sisters who were selling produce at a farmers’ market, said they disliked the individual mandate even though they thought everyone should have access to health care. Both women are uninsured, but since they are struggling to make ends meet, they fear being required to buy coverage.
“I don’t think it’s right,” said Ms. Zimmerman, 49. “If you don’t want it or can’t afford it, then what? You’re stuck.”
The sisters would probably qualify for subsidized insurance under the law, but since the subsidies would come in the form of tax credits, Ms. Zimmerman said they would be cold comfort. “Even if they gave you tax credits,” she said, “you couldn’t get that until April. What are you going to do the rest of the year?”
(In fact, people who qualify for the credits would not have to wait until filing their taxes to receive them under the law.)
Mr. Schiff’s wife, Sandy — like him a retiree and registered Democrat who thinks the law does not go far enough — said she thought many Americans were not interested in figuring out how it would work.
“A lot of people say, ‘Don’t confuse me with the facts,’ “ Ms. Schiff said. “It’s an emotional issue.”