President Obama plans to open a new campaign this week to persuade skeptical Americans that the bill holds immediate benefits for them and addresses the nation’s shaky fiscal condition. Republicans said they would seek to repeal the measure, challenge its constitutionality and coordinate efforts in statehouses to block its implementation.
The politics of health care are fragile — and far from certain — in the eight-month midterm campaign that will determine which party will control Congress next year. But both sides steeled for a fight to extend well beyond November, involving state legislative battles, court challenges and, ultimately, the next presidential race.
Even before the final vote, Republicans began relentlessly assailing lawmakers who supported the legislation, suggesting Democrats are spendthrift and proponents of big government. Democrats said they would seek to capitalize on the momentum from their success and strive to move beyond the political arguments in hopes of demystifying the complicated legislation.
Kathleen Sebelius, secretary of health and human services, offered an early argument on Monday morning, saying she thought the public image of the bill had been hurt by “a lot of attempts to confuse and scare Americans.”
Appearing on “The Early Show” on CBS, Ms. Sebelius said that she, the president and the majority party were convinced that once Americans learn how the legislation might improve their lives, “they’ll be very enthusiastic about what Congress did last night.”
Among the points she cited were the bill’s ban on the insurance company practice of excluding children with pre-existing medical conditions from coverage, provisions meant to lower prescription drug expenses for some elderly Americans, and more funds to help pay for preventive care.
“The president has said from the beginning this bill was about health care for all Americans — for small-business owners, for families in desperate shape,” she said.
The next chapter in the health care fight will play out not only in the midterm elections, but also in the courts. Attorneys general in three states — Virginia, Florida and South Carolina — have indicated they will file legal challenges to the measure, arguing that its requirement that individuals buy insurance is a violation of the Constitution. In an interview Sunday, the Virginia attorney general, Ken Cuccinelli, said he intended to base his challenge on two grounds: that the federal bill conflicts with a newly passed state law that says no Virginian may be compelled to buy insurance, and that Congress does not have authority to impose the mandate under its powers to regulate interstate commerce, as Democrats contend.
“This is such an incredible federal overreach,” Mr. Cuccinelli said, but added that he did not plan to ask the courts for an order that would prevent the bill from going into effect because the individual mandate does not take effect until 2013. “On our basis for a constitutional challenge, there’s no rush,” he said.
The White House and Democrats were preparing to counter the legal arguments and coordinate a state-by-state response to any prospective challenges. For his part, aides said, Mr. Obama will lead the effort to define the bill, but also will shift his focus to the economy and jobs. A campaign, featuring Mr. Obama and examples of people who benefited from health care, will take place in the coming months.
Democrats were also beginning to form a permanent campaign, of sorts, to follow the bill through its various stages. Party strategists studied the public’s reaction to Medicare — it was not immediately positive — and were trying to create a friendlier climate for Mr. Obama when he faces voters again.
A fresh multimillion-dollar wave of television and radio advertisements was to begin Tuesday morning, with groups on both sides of the contentious health care issue trying to influence the lasting impressions about the long legislative debate.
The president of the United States Chamber of Commerce, Thomas J. Donohue, pledged to keep opposing the health care measure “through all available avenues — regulatory, legislative, legal and political.” And organizations supporting the legislation, including AARP and labor unions, intend to defend the bill and run commercials to thank lawmakers for their votes and to extol what they see as benefits.
The coalition, known as Unity 10, has worked closely with the White House for the last year. The goal over the short and long term, organizers said, was to protect politics from health care and protect health care from politics.
When vulnerable Democrats who supported the legislation return to their home districts later this week, they will be met with billboards at airports and rallies. They have been advised not to say they voted for the bill out of courage, aides said, because that suggests it was politically risky, and possibly, a wrong decision. To explain the bill, lawmakers have been given a district-by-district analysis filled with facts and tidbits. Take Representative John Boccieri, the Ohio Democrat who drew praise from Mr. Obama in a weekend visit to the Capitol for supporting the bill “in as tough a district as there is.”
The analysis of Mr. Boccieri’s district, typically carried by Republicans, says the bill would give tax credits to up to 167,000 families; improve Medicare for 111,000 beneficiaries; extend coverage to 38,500 residents; guarantee that 9,800 residents with pre-existing conditions can obtain coverage; allow 49,000 young adults to remain on their parents’ plans; and so on.
“This is not a bad debate to have,” said Andy Stern, president of the Service Employees International Union. “If the debate is about big government, it will not be the right debate to have. It’s about your life, your doctor, your hospital.”
Senator John Cornyn of Texas, chairman of the National Republican Senatorial Committee, said passage of the health care bill would be “a bonanza” for Republicans in states like Arkansas, Nevada and particularly Indiana, where Representative Brad Ellsworth, a Democrat, is running for the Senate and voted for the bill.
“It seems like it’s a kamikaze mission on his part,” Mr. Cornyn said in an interview on Sunday.
Democrats argue that the bill has deep political benefits, particularly because some of its popular provisions — allowing young adults to stay on their parents’ health plans until they turn 26, for instance — will kick in this year, while the unpopular provisions, like the mandate to buy insurance, will not take effect until much later.
Mr. Cornyn said Republicans would spotlight other provisions, like changes in private Medicare Advantage plans, which will also kick in quickly and are worrisome to older people.
Republicans also expect to take advantage of the fact that while the health bill may ultimately help contain rising premiums, it is unlikely to actually bring the cost of health insurance down, and certainly not in the short term.
“The question you’re going to see Republicans asking in November is, ‘Have your health insurance costs gone down?’ ” Mr. Cornyn said. “And I think the answer to that is going to be no.”