President Barack Obama's big new healthcare law largely delivers on more than two dozen specific promises he made as a candidate, but that isn't winning him points with the public.
Although Americans are divided over the wisdom of his far-reaching blueprint for expanding coverage, they basically got what a majority voted for when they elected Obama in 2008.
"No one has the right to say they were misled during the campaign," said healthcare industry consultant Robert Laszewski, a critic of the law.
"For all the controversy, what (Obama) has done in healthcare is consistent with what he promised. It's really very close."
Obama kept most of his promises, but not all. A tax penalty on people who don't get the health insurance — starting in 2014 — will hit some middle class households.
As a candidate, Obama called for putting the U.S. on a path to coverage for all by building on the existing healthcare system, in which most workers and their families get private insurance through an employer.
He proposed tax credits to help people whose jobs didn't come with health benefits, and he wanted large employers to contribute to the cost of coverage.
His plan required insurers to accept all applicants, regardless of medical problems. It recommended a new, competitive health insurance market for people buying coverage on their own and expanding Medicaid to more low-income people.
The 10-year, nearly $1 trillion plan Obama signed into law March 23 incorporates those major elements, with some tweaks.
The tax credits and the Medicaid expansion won't come until 2014, to keep down the initial cost of the bill. The ban on denying coverage to any person in poor health also won't be in place until then.
New health insurance markets for individuals and small businesses will be state-based, instead of national as Obama originally sought. The Congressional Budget Office says the plan will cover 95 percent of eligible Americans under age 65 by the year 2016, compared with 83 percent now.
But polls show the public is split over the law, and those who don't like it hold stronger opinions — a worry for Democratic lawmakers running for re-election this fall.
"After huge debates in American history, sometimes the public rallies behind whatever the decision turns out to be — in this case they remain divided," said Robert Blendon, a Harvard public health professor who follows opinion trends.
One promise that Obama broke — and one that many doubt he ever will fulfill — may help to explain the unease.
While most of the tax increases in the bill fall on upper-income earners, middle-class households will bear some. That's a broken promise from a president who gave broad assurance he would not raise taxes of any kind on families making less than $250,000.
For example, the brunt of a new tax penalty for failure to get health insurance will fall on middle-class households, according to congressional budget analysts. That tax is in the law because Obama changed his mind whether Americans should be required to carry health insurance. As a candidate, he had proposed only a requirement that parents get their kids covered. (The penalty can be waived in cases of financial hardship.)
"I have to say that I believe the promises broken will mean much more to the American people," said Grace-Marie Turner, president of the Galen Institute, a conservative public policy research center.
Others doubt average Americans will see the tax penalty as a broken promise. "I don't view that as a tax increase, I view it as a fine," said economist Karen Davis, president of the Commonwealth Funds, a research center that supported the broad goals of the overhaul. "Fines you are subject to if you don't adhere to requirements, in my mind, are not the same thing as general taxes."
But economist Joe Antos of the business-oriented American Enterprise Institute says billions of dollars in fees on insurers, drugmakers and medical device manufacturers also will be passed on to average consumers. "It is a political fiction that only the companies pay," Antos said.
Obama didn't keep his promise on negotiating the healthcare bill in front of C-SPAN cameras and creating a government health plan to compete with private insurers.
Many Obama promises in the law are in stages of delivery, usually due to long lead times for major changes. Others say most of those promises should count as kept because the law says they will be carried out.
But it's the yet-to-be-fulfilled promise that's most likely to determine whether the healthcare overhaul ultimately wins broad acceptance.
Obama promised to cut the cost of a typical family's health insurance premiums by $2,500 from projected prices if no changes had been made.
Perhaps. But polls show many people believe their premiums will go up.
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