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Feature US Elections

How US politicians are playing the health card

BMJ 2012; 345 doi: (Published 27 September 2012) Cite this as: BMJ 2012;345:e6413
  1. Michael McCarthy, editor
  1., Seattle, Washington, USA
  1. Michaelmccarthy007{at}

Michael McCarthy looks at how the health debate is unfolding in the run up to the US elections

When the US Supreme Court, in a narrow five to four decision, upheld President Barack Obama’s 2010 health reform law in June, many Republicans, though disappointed with the ruling, felt the court had handed them a winning election issue.

The law, the Patient Protection and Affordable Care Act (ACA), remains unpopular with many voters, and Republicans saw the court’s decision as an opportunity to make the upcoming election a referendum on the act, which they had dubbed derisively as Obamacare.

“If we want to get rid of Obamacare, we will have to get rid of Obama,” said Mitt Romney, the Republican candidate for president, after the court’s decision. Romney has repeatedly promised to act to repeal the law on the day he takes office, should he be elected.

Since the court’s decision, the Republican strategy has been “to just hammer on the unpopular aspects of the ACA and deflect any questions about what they would do in place of the law,” said Bradley Herring, associate professor in the Johns Hopkins Bloomberg School of Public Health’s department of health policy and management in Baltimore. “You talk about the law taking money out of Medicare; you talk about death panels; you talk about the unpopular individual mandate.”

The Democrats’ defense had been hampered because the law is complicated and because many of its important provisions that Democrats believe will be popular do not come into effect until 2014.

In the meantime, the Democrats’ strategy has been to focus on the popular provisions that have been implemented, said Herring, such as provisions that guarantee coverage for children with pre-existing conditions, allow young adults to remain on their parents’ health plans until they turn 26, and …

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