Healthcare debate enters new phase

WASHINGTON (Reuters) - Now that the great healthcare debate is finished, it's starting all over again.

Both President Barack Obama's Democrats and Republicans see ways to gain a political advantage from a healthcare overhaul that passed narrowly in the House of Representatives.

An effort to frame the debate is already under way to try to sway voters ahead of November congressional elections. Look for both sides to cast the legislation in a light that is most favorable to their arguments.

Democrats are focusing on the popular aspects of the bill -- like ending medical insurer's ability to cut off coverage to people with pre-existing conditions -- to make the case that all Americans stand to gain, not just those currently without insurance.

"If you have health insurance, this reform just gave you more control by reining in the worst excesses and abuses of the insurance industry with some of the toughest consumer protections this country has ever known -- so that you are actually getting what you pay for," Obama said.

Republicans are zeroing in on the costs of the $938 billion legislation and raising questions about whether a new government entitlement can truly be paid for simply by increasing taxes on the wealthy.

"His health-care bill is unhealthy for America," said Mitt Romney, a potential Republican presidential candidate in 2012. "It raises taxes, slashes the more private side of Medicare, installs price controls, and puts a new federal bureaucracy in charge of healthcare."

The debate will play out for the next seven months as Democrats seek to protect their strong majorities in the House and Senate while Republicans try to make a comeback after defeats in 2006 and 2008.

OBAMA MUST SELL BILL

There is no doubt that passage of healthcare, two months after it was on life support when a Republican won a pivotal Senate seat, gave Obama's presidency a critical victory.

Now his challenge is to sell a bill that has been unpopular with Americans who do not see what they gain out of it.

Indeed, Americans are even confused about it after a year-long debate.

A CBS News poll found only 29 percent of Americans believe the overhaul will make the system better, while 34 percent said it would make it worse and 28 percent said they were not sure.

"Unless the Democratic message machine is a whole lot better in the next eight months than it has been in the last eight months, they could fail to make the sale this November," said Bill Galston, who was a domestic policy adviser to President Bill Clinton.

"The biggest mistake the Democrats could make, and I don't think they're going to make it, is to believe that somehow this bill will speak for itself. It won't," he said.

Republicans see plenty of room to maneuver in their bid to overtake the Democrats' large advantage in the House and Senate. All House seats are up for grabs in November and more than a third of Senate seats.

Republican pollster Whit Ayres said recent polling he helped conduct showed independent voters that are often the key to elections were strongly opposed to the healthcare package.

"In centrist or Republican-leaning districts, it's going to be a firestorm," he said. "There are some Democrats who cost themselves seats yesterday."

But even big gains for Republicans in November could be cold comfort for those conservatives who saw the healthcare victory as a major defeat for their cause of limited government.

David Frum, a former speechwriter for President George W. Bush, wrote in a blog on Monday that even with big gains in November, "So what? Legislative majorities come and go. This healthcare bill is forever. A win in November is very poor compensation for this debacle now."

While Republicans speak of seeking to repeal the legislation, many experts doubt this would be politically palatable.

A perhaps more critical question is whether the legislation's requirement that all Americans purchase medical insurance is constitutional.

Already, this basic question is the subject of lawsuits to be filed by at least 11 states.

"The health care reform bill, with its insurance mandate, creates a conflict of laws between the federal government and Virginia," said Virginia Attorney General Ken Cuccinelli, who filed suit on behalf of his state.

(Editing by David Alexander)