WASHINGTON (USA TODAY) - The health care overhaul that President Obama intended to be the signature achievement of his first term instead has become a significant problem in his bid for a second one, uniting Republicans in opposition and eroding his standing among independents.
In a USA TODAY/Gallup Poll of the nation's dozen top battleground states, a clear majority of registered voters call the bill's passage "a bad thing" and support its repeal if a Republican wins the White House in November.
Two years after he signed the Patient Protection and Affordable Care Act - and as the Supreme Court prepares to hear arguments about its constitutionality next month - the president has failed to convince most Americans that it was the right thing to do.
"Mandating that you have to buy the insurance rubs me the wrong way altogether," says Fred Harrison, 62, a horse trainer from York County, Pa., who was among those surveyed and supports repeal even though he likes some provisions of the law. "It should be my own choice."
"It seems like it forces you to take health care (coverage), and you don't really have a say in the matter," says Beth Leffew, 26, a college student from Cincinnati. She says the president "didn't really listen to people" when they objected to the proposed bill. "It seems like he just shoved it right through Congress."
Though the law has avid supporters, especially in the president's Democratic base, the net effect among middle-of-the-road voters is negative for him. What's more, the issue unites the GOP when the party is fractured among competing presidential contenders.
In the poll, Obama lags the two leading Republican rivals in the 12 states likely to determine the outcome of a close race in November:
Former Pennsylvania senator Rick Santorum tops Obama 50%-45% in the swing states. Nationwide, Santorum's lead narrows to 49%-46%.
Former Massachusetts governor Mitt Romney edges Obama 48%-46% in the swing states. Nationwide, they are tied at 47% each.
Romney also has a health care problem: Among Republicans and Republican-leaning independents in the battleground states, 27% say they are less likely to support him because he signed a Massachusetts law that required residents to have coverage. Just 7% say it makes them more likely to back him.
"If they used Mitt Romney's Massachusetts health care program as a guideline for the Obamacare thing, what's the difference?" says Robert Hargrove, 37, of Sanford, N.C., rejecting Romney's explanation of differences between the state and federal laws. Hargrove, a truck driver for a propane company, scoffs: "It's just a bigger version. They put it on steroids."
The swing states poll of 1,137 registered voters was taken Feb. 14-21. In addition, a national survey of 881 registered voters was taken Feb. 20-21. The margin of error for each is +/-4 percentage points.
The battleground states surveyed include Michigan - where Tuesday's primary has become a critical showdown between Romney and Santorum - as well as Ohio and Virginia, which vote next week on Super Tuesday. The other swing states are Colorado, Iowa, Florida, Nevada, New Hampshire, New Mexico, North Carolina, Pennsylvania and Wisconsin.
Health care ranks near the top of a list of concerns for advocates and critics of the law. Nationwide, it trails only the economy and the deficit as being the most critical issues facing the nation, rating a bit higher than unemployment and terrorism.
Lynn West, 58, a retired state education official from Boscawen, N.H., is exasperated that a law she says has been "fabulous" for her family continues to draw so much heat. Under its provisions, her 24-year-old son has been able to stay on his father's health insurance plan after graduating from the University of New Hampshire two years ago. Her 77-year-old mother, who lives in nearby Concord, has seen her prescription costs decline.
"If you say the word 'Obamacare' - Republicans have made that a dirty word," says West, who was among those surveyed.
"If I had to fault President Obama or the people that help him put out his message, I think they need to be simpler. A lot of times it's the catch phrases that catch fire, like when he said, 'Yes we can' " in the 2008 campaign. "That's why the term 'Obamacare' has worked - a simple phrase, and they've been able to put a negative connotation to it. In fact, they ought to be saying, 'Obamacare! Let's rejoice!' "
Bragging and basketballs
Thursday night at the mansion of Dallas Mavericks star Vince Carter in Orlando, Obama bragged about the law to a crowd of about 70 campaign contributors who had paid $30,000 each to attend.
"We were able to pass a health care bill that is already providing 2.5 million young people insurance who didn't have it before, and by the time it's fully implemented, will give 30 million people health insurance," the president told the audience gathered at Carter's indoor basketball court.
Although touting the Affordable Care Act is part of Obama's standard pitch at political events such as that one, at larger presidential events, he is more likely to be focused on proposals to foster jobs or promote education. In the State of the Union address in January, he referred to the health care law in only two sentences, almost in passing.
The Republicans seeking the presidential nomination hammer the law at every opening - at times targeting not only Obama but also Romney.
"Romneycare was the model for Obamacare and the government takeover of health care," Santorum declared at last Wednesday's debate in Mesa, Ariz. "It would be a difficult task for someone who had the model for Obamacare, which is the biggest issue in this race of government in control of your lives, to be the nominee of our party."
Romney replied that the Massachusetts plan differed in fundamental ways from the federal one. Then he tried to turn Santorum's charge back on him.
"The reason we have Obamacare is because ...Arlen Specter, the pro-choice senator of Pennsylvania that you supported and endorsed in a race over Pat Toomey - he voted for Obamacare. If you had not supported him, if we had said 'no' to Arlen Specter, we would not have Obamacare. So don't look at me. Take a look in the mirror."
Opposition to the federal law is nearly uniform among Republican voters. In the battleground states, eight in 10 say passage of the law was "a bad thing." Nearly six in 10 want it repealed. Nine in 10 say the law's provision requiring Americans to have health insurance or pay a fine is unconstitutional - the centerpiece of a challenge before the Supreme Court.
The issue is whether Congress can force people to buy health insurance or pay a fine, a mandate that the law's architects say is critical for the goal of expanding coverage and one that has divided judges on federal appeals courts. Arguments before the high court are scheduled to begin March 26, three days after the second anniversary of the law's signing.
Voters in swing states stand overwhelmingly on one side of the debate: Three of four voters, including a majority of Democrats and of liberals, say the law is unconstitutional.
That reaction is almost instinctual, says Stuart Altman, a professor of national health policy at Brandeis University who has joined two briefs supporting the law. "People say, 'The government should not mandate that I have to do anything.' "
He faults the Obama team for not responding effectively enough to what he calls a "torrent" of opposition and misinformation.
"You have this drumbeat of negative comments and almost no positive," he says. "You're relying on the president to do the selling, and he's moved on to other things. The congressional people on the Democratic side are not supporting it. They're either being very quiet or running away from it themselves because they're afraid of getting tarnished."
"That debate will be had," says Stephanie Cutter, Obama's deputy campaign manager. When the public is engaged in the general election, "there will be an intensive effort to ensure that families understand how they're already benefiting from the law and what would be taken away from them if Mitt Romney or Rick Santorum has their way. The American people do not want to go back to the days of insurance companies discriminating against you if you have a pre-existing condition or dropping your coverage if you get sick."
That will be a hard sale to make to Hargrove, the North Carolina truck driver. He acknowledges there are provisions in the law he calls "good and needed." His 4-year-old son, Matthew, was born with a hole in his heart, requiring expensive surgery. Hargrove notes that the law's bar on insurers refusing coverage to those with pre-existing conditions could protect kids such as his.
"But the way it was done, passed before it was read and all this other stuff, that's underhanded," he says. "You've got to have it or pay a penalty? That's not the way the country was set up."
Wariness about the future
Gail Wilensky, a top health care policymaker for President George W. Bush and critic of the law, says Americans remain wary of the long-term impact of its provisions, which don't go fully into effect until 2014. At this point, she says, "they are not seeing much in the way of positives, and they are concerned about the negatives it might have."
Eleven percent of voters in battleground states say the law has helped their families; 15% say it has hurt. Looking ahead, they predict by 42%-20% that the law will make things worse rather than better for their families.
A pocket of support: those under 30, a critical age group for Obama in 2008. They are inclined to call the law's enactment "a good thing." Even among them, the share of supporters falls just short of 50%. The older the age group, the more opposition emerges.
Opposition to the law is eroding Obama's support among the middle-of-the-road voters both nominees will court this fall. Among independents, 35% say the law makes them less likely to support Obama, more than double the 16% who say it makes them more likely.
The intensity of feeling among potential swing voters also favors opponents. Among independents who lean to the GOP, 54% say they are much less likely to support Obama as a result. Among independents who lean to the Democrats, 18% say they are much more likely to support him.
Jason Carr, 40, a federal public defender in Las Vegas who describes himself as a moderate, credits the Obama administration with addressing a problem people had been talking about for decades. "You may not like what they did, but they did something," he said in a follow-up interview after being polled. He is likely to vote for Obama in November but would consider Romney if he was the Republican nominee.
Vivian Robertson, 65, a retired nurse from Bangor, Wis., hasn't decided whom to support in the state's Republican primary on April 3, but she knows she won't vote for the author of Obamacare in November.
"I think it's terrible," she says of the law. "It's going to take our medical system, and it's going to go right down the drain."
Susan Page, USA TODAY