O health care, where art thou?
For health policy wonks, Tuesday night’s State of the Union speech wasn’t a thriller. President Obama mentioned Medicare and Medicaid... once. “Health care” got two shout-outs. The Affordable Care Act? Not even a name-check. The GOP rebuttal from Indiana Gov. Mitch Daniels was equally spare, with no mention of repeal.
In the lead-up to an election year, the State of the Union address is often read as an opening campaign gambit, laying out political contrasts that will define the next 11 months. So does last night’s speech mean health care is getting left on the campaign cutting room floor?
The answer could be yes, with good reason: Spending too much time defending the health reform law gives weight to the threat of repeal, recognizes it as legitimate. That uncertainty, it turns out, tends to make voters more resistant to the law. In refraining from talking about a major, recently passed health care legislation, Obama actually has some company: President Lyndon B. Johnson didn’t even mention Medicare in his 1966 State of the Union address, which happened just 12 days after the new entitlement programs for seniors rolled out. In his 1967 speech, he mentioned the program just twice.
Meanwhile, there’s not much to gain by talking a lot about the Affordable Care Act: The health reform law doesn’t move voters. The country has been stubbornly split on the health reform law since it passed in 2010. Monthly tracking polls have found little permanent movement in either direction.
Even if it was an issue that could win parts of the electorate, it’s not a place where there’s much more contrast for either party to build. We already have a pretty clear sense of who would keep the Affordable Care Act and who would repeal it (hint: the former is currently in office). Here’s how Harvard’s Robert Blendon put it to me in a recent interview, “For the base, the president will say I’m committed to it. The Republican candidate will say I’m going to get rid of it. But it’s not going to move a lot of people.”
In the 44 words that President Obama did spend on health care, that’s pretty much the case he made. “I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny you coverage, or charge women differently from men,” Obama said Tuesday night.
That’s likely not the last we’ll hear from the president on the law: In the coming months, a number of events will force a discussion on the Affordable Care Act. The Supreme Court will take up the Affordable Care Act’s constitutionality this term with oral arguments in March and a decision by late spring. The health reform law will hit its second year anniversary on March 23. House Speaker Rep. John Boehner has committed to putting Medicare on the agenda. Between Congress and the courts, and events along the 2012 election cycle, there will be plenty of talk about health care — whether the candidates like it or not.