Democrats are pushing to shore up support for the U.S. healthcare overhaul signed into law by President Barack Obama, but the final public verdict will largely depend on how smoothly it is put into effect.
Some of the biggest changes to the $2.5 trillion healthcare system are put off until 2014, but a number of benefits are slated to go into effect this year.
"The experience of people with reform will make more difference in long-term support than anything else," said David Kendall of Third Way, a centrist think tank.
The healthcare overhaul is a huge victory for Obama heading into the midterm congressional elections in November as his fellow Democrats try to hold on to their majorities in the House and Senate.
But polling data show the public is skeptical of the coming changes even though many agree the system as it stood cost too much and left too many people without coverage.
Republicans have vowed to work to repeal the law, arguing it gives the government too big a role in healthcare and that it will bankrupt the country.
In a memo to Republicans in the U.S. House of Representatives last week, House Minority Leader John Boehner said they would "fight to repeal this government takeover of healthcare so we can start over on common-sense reforms that lower costs for families and small businesses."
Democrats and advocacy groups have begun public information campaigns to counter Republican criticisms and to try to improve the public perception over the next few months.
"In order to win the public sympathy and win public support they are going to not only want the implementation to be smooth but also for the public to recognize the benefits coming out of health reform," said Eric Zimmerman, a specialist in Medicare law with McDermott Will and Emery LLP. "It's going to be a challenge."
Within months, young adults up to the age of 26 will be able to stay on their parents' health plans, insurers will no longer be able to drop people from coverage when they get sick, and new policies will be required to provide preventive services free.
Restrictions will be placed on annual and lifetime coverage caps, and many small businesses will be able to tap into new tax credits to help pay for their employees' health coverage.
One of the most challenging provisions for federal and state regulators to implement may be the new high-risk pools for people with pre-existing conditions who have been denied coverage.
The law provides $5 billion to finance these temporary pools that are to be established within the next three months. The pools expire in 2014 when the state insurance exchanges, where individuals and small businesses can shop for policies, are up and running.
Some 35 states already have some sort of high-risk pools, but they function with varying degrees of success, analysts said. The trick going forward is providing coverage for people and getting an affordable premium, they said.
"There is definitely concern about the states and some states will do a better job than others," said Richard Kirsch, of Healthcare for America Now, a liberal advocacy group.
"Some states have more experience, some states have more competent administrations, and some of us also worry that there may be times that for political considerations governors are not interested in doing as well," he added.
More than a dozen states have challenged the law on constitutional grounds arguing the federal government has no authority to require people to purchase health insurance.
Democrats argue the case is without merit, but if opponents succeed in striking down the coverage mandate, it would "blow a gaping hole in the whole framework of reform," said Zimmerman.
Longer term, signing up 32 million uninsured people for new coverage will be a challenge, says Ron Pollack, who heads Families USA. The advocacy group is undertaking a public education campaign to sort fact from fiction, he said.
"Now that we've got legislation passed so that people can learn how it will affect their lives, I think the popularity of it is going to soar," Pollack said.
Pollack's group is also spearheading an effort with other public interest and business groups to make sure enrollment for government insurance subsidies that go into effect in 2014 and the expanded Medicaid program for the poor goes smoothly.
That effort includes America's Health Insurance Plans, the insurance industry group that fought the overhaul.
The new enterprise call "Enroll America" is a broad collaborative effort to help create a system that will make it easy for people to enroll in new program benefits, he said.
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