Will Republicans or Democrats Turn Obamacare Into Political Gold?

Many predictions circulate in the months preceding any political election. Some are the product of careful thought; some are the result of undue enthusiasm or bluster; the rest fall everywhere in between. Those made by politicians themselves often seem to fall into the latter category. But even if such predictions are made within the election atmosphere with full knowledge that the words will shape voter perceptions, they are important because they set the parameters of the debate.

With midterm congressional elections mere months away, Washington, D.C., is focusing on the issues that will drive campaigns, especially healthcare reform. Given the exceedingly partisan nature of the national discussion surrounding the Affordable Care Act, it is no surprise that U.S. lawmakers on either side of the aisle have taken very divergent views on how healthcare reform will influence the pre-election debate.

House Minority Whip Steny Hoyer, a Democrat from Maryland, said during a Tuesday news conference that Obamacare would not be the political handicap for congressional Democrats in November’s midterm elections. “I think healthcare at worst is going to be a neutral in this election,” he argued.

When the Affordable Care Act’s enrollment numbers began to improve earlier this year, a theory was put forward that this November’s midterm elections would not be a referendum on the healthcare reform championed by President Barack Obama.

That argument — with enrollment numbers surpassing the nonpartisan Congressional Budget Office’s highest target – has gained momentum in the weeks since the six-month enrollment period for the Affordable Care Act came to a close at the end of March.

The president himself professed in an April speech that members of his party would benefit from the healthcare reform’s success in the congressional midterms. When asked by by Politico’s Edward Isaac-Dovere at a news conference whether he would advise members of his party to campaign on the Affordable Care Act, Obama said, “I think Democrats should forcefully defend and be proud of the fact … we’re helping because of something we did.”

Republicans have to keep in mind that 8 million potential voters have enrolled for coverage through the exchanges, and that reality has complicated the party’s repeal efforts. However, this is not to say that the most fundamental tenant of the healthcare reform debate is changing. Democrats still argue that the healthcare reform is the most ambitious social program implemented in the United States since Medicare was passed in the 1960s, while Republicans say it has put the United States on the slippery slope to socialism and a destroyed healthcare system.

After all, it is election year and Republican lawmakers up for reelection need to appease those voters who want Obamacare repealed without alienating their more moderate constituents. But more importantly, the party’s leadership is aware that the same arguments against the individual insurance mandate can no longer be made.

Even so, Hoover Institute senior fellow Lanhee Chen said Tuesday on Bloomberg View that “a lot of Democrats would be smart to run as far as they can away from Obamacare.” It is his opinion that the healthcare reform is a political liability for the party and that Democrats will “suffer electoral consequences.” His reason for that assessment is not the error-riddled rollout of the federal healthcare website.

Rather, he said the failures of the website are emblematic of some of the failures of Obamacare more broadly. He did not explain that relationship, but it is easy to imagine that he was suggesting the administration did not invest enough time or care to ensure the reform was feasible, or that the administration was far too focused on helping one sector of the country without preparing for how that change would impact the broader population.

The White House perspective is that the reform is “working fabulously,” according to Chen, per Bloomberg View. But the fact remains that the public’s opinion on Obamacare still tilts negative. A Washington Post/ABC News poll released Tuesday revealed that only 44 percent of respondents support Obamacare, while 48 percent said they oppose the healthcare law. In addition, Gallup found that more Americans say their vote in the midterm election will be a message to oppose, rather than support, Obama.

Of course, that response is typical for less-popular presidents in midterm election years. And while not explicitly linked to the Affordable Care Act, the fact that a majority of Americans are displeased with the administration suggests that Obamacare will be a major campaign issue. The special runoff election in Florida, the first major test of voter attitudes in 2014, showed just how much of a burden healthcare reform could be for the Democratic Party. Campaigning on a repeal and replace platform, Republican David Jolly won a narrow victory.

If Obamacare is indeed a prominent issue in the upcoming elections, anecdotal evidence will feature as the basis for many a debate, as it already has. A common feature of the president’s speeches on the Affordable Care Act is the recounting of the positive experiences of those who have purchased policies through the insurance exchanges.

For example, in a April 1 speech that marked the conclusion of the enrollment period, the president sought to humanize the law’s impact, pointing to the fact that “millions of our fellow citizens know the economic security of health insurance who didn’t just a few years ago.” That gain, he noted, “regardless of your politics or your feelings about me, or your feelings about this law, that’s something that’s good for our economy, and it’s good for our country.”

Republicans have trucked out their own examples, but Democrats have been quick to undermine those stories. Most notable is a case cited by Senate Majority Leader Harry Reid of Nevada when he took to the floor earlier this year in order to speak out against advertisements paid for by the Koch brothers that depicted Obamacare horror stories.

In particular, Reid denounced an Americans for Prosperity television ad that featured Julie Boonstra, a leukemia patient, who testified about the financial injustice done to her by the health law. She said that her previous policy had been cancelled, leaving her without access to medication she needed to survive. Critics widely questioned the validity of that story, although the organization has stood by the advertisement.

The Washington Post’s fact checker found that Boonstra would save approximately $529 per month on her premium under that new plan, which adds up to an annual total of $6,348 — just $2 shy of the out-of-pocket maximum, meaning the total yearly amount on healthcare that Boonstra would pay would be about equal, regardless of her plan.

In fact, a critical eye has been turned on the entire catalog of Obamacare horror stories that Republicans have showcased. One such tale — the story of Marine veteran Christopher Schiff, who said his “insurance costs are going way up because of Obamacare” — has been largely ignored. Comparatively, the story of Dean Angstadt, a self-employed logger who eventually purchased a healthcare policy just in time for heart valve replacement surgery, has garnered much more attention. As he told the Philadelphia Inquirer, “The ACA is everything it’s supposed to be and, in fact, better than it’s made out to be.”

Because of the apparent dearth of so-called Obamacare horror stories circulating through the media, it has been suggested they are not to be recounted. “After months of watching the press obsess over ‘rate shocks’ and sensationalist stories about skyrocketing premiums and an endless parade of (usually bogus) tales of victimhood, we’re starting to see positive ACA stories break through the noise and take on a life of their own,” wrote Salon’s Simon Malay earlier this month.

Analysts and Republican critics alike have warned that in 2015, the story may be different. As Chen said to Bloomberg View, the ultimate Obamacare debate is whether healthcare becomes more expensive or cheaper over the long run. Insurance executives have already warned about the likelihood of double- or triple-digit premium hikes. The reason is that 2014 enrollments were largely older and sicker individuals.

“I do think it’s likely premium-rate shocks are coming,” Chet Burrell, chief executive officer of Care First BlueCross BlueShield, has said. “I think they begin to make themselves at least partially known in 2015 and fully known in 2016.” Even worse, Aetna CEO Mark Bertolini has said that increases “could go as high as 100 percent.” Next year is also a big year for the Affordable Care Act because the employer insurance mandate will go into effect.

The possibility of coming rate hikes has already been worked into Republican Party rhetoric. “Obamacare exchange plans will have increased premiums due to increasing costs and the increased utilization of health services,” reads the subheading of a recent blog posted to a GOP website. Quoting an article published by The Hill on Thursday, the blog reads, “However [a leading healthcare analysis] group said increasing cost of medical care, use of services and new technology will mean exchange plans will need to increase their premiums, and the hikes will vary state-by-state.”

The GOP already argues that use of the health services has surged, pointing to the first quarter’s gross domestic product data, which showed that spending on health services increased by 9.9 percent. To the reform’s critics, this growth is evidence that the law did not bend down the curve of health care spending, as the administration promised. Political commentators on the left were quick to respond, arguing that the increase in spending merely reflected the fact that more people were able to use health care services because of their new insurance.

But while the left will argue that Republicans are grasping at straws when reaching for negative Obamacare anecdotes, it seems that election strategy this upcoming year will rest, at least to a small degree, on these stories. Take for example, Kentucky junior Sen. Rand Paul and Rep. Lee Terry of Nebraska.

Terry, who is basing his campaign on repealing the Affordable Care Act, has already broadcast an advertisement featuring a constituent hurt by the reform. “When I first saw the letter telling us that our old policy was going away, I was very, very concerned. I knew immediately this was going to be a financial struggle for our family,”Andrea Kodad, a mother of two, tells the camera.

The ad tells the viewer that Kodad’s plan was canceled and her new premium rates from her policy purchased through the state’s exchange added almost $300 to her monthly expenses. At the end of the ad, the camera focuses in on her policy statement, showing that the family’s premium had risen from $446 a month to $726.

There is no denying that the American public did not benefit from the reform across the board. Depending on age, health status, state of residence, income, and a whole host of factors, individual experiences differ substantially. That has made anecdotal evidence the perfect campaign tool, as there are stories to suit every purpose.

Still, there is a problem with this anecdote. After the public realized that Obama had failed to deliver on his “If you like your plan, you can keep it” promise, his administration urged states to allow a two-year expansion to noncompliant plans, and Nebraska did. Blue Cross Blue Shield of Nebraska, Kodad’s insurance company, displays a notice on its Web site that reads plans can be extended for another two years, meaning Kodad could have kept her plan.

The Washington Post’s fact checker attempted to contact Kodad. She did admit that her old plan had been extended, but added that “the spirit of the ad” was to highlight “what the true Obamacare costs are.” In addition, Terry’s spokesman, Kurt Bardella, told the publication that “We never said they did go up that amount but rather when she got the notice — that was the reality she was confronting,” adding that Obamacare creates uncertainty for Americans.

As for Paul, the Kentucky senator’s website is sourcing the Obamacare stories of his constituents. And he has already made his own erroneous Obamacare claims. In a newsletter circulated May 2, Paul noted that “for every Kentuckian that has enrolled in Obamacare, 40 have been dropped from their coverage.” But in actuality, nearly 331,000 people have signed up for Medicaid, according to state officials, while 83,000 have enrolled in exchange plans, for a total of 413,000 people. That figure far outweighs the 168,000 plans (individual and small group) that were canceled.

While such stories may play a role in the upcoming congressional midterms, by the 2016 presidential election, the Hoover Institute’s Chen said to Bloomberg View that he believes the battle of anecdotes will have subsided, and that Republicans will need to have “proactive solutions” on which to campaign.

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