Obama still faces health care reform traps

Health care reform is in the same political realm as climate change, with the country divided among those who believe it is settled, those who doubt everything about it and those waiting for more evidence.

Passage of the Patient Protection and Affordable Care Act hasn't settled the issue or calmed the politics before this year's congressional elections. Instead, it has raised the stakes for President Obama and his party to assure millions of doubters that this is the right public course on an intensely personal issue.

But it also has created treacherous ground for Republicans, many of whom are preparing to run for office this fall on a promise to repeal the measure. Without a solid, specific alternative that looks both politically possible and addresses real concerns about the health care system, Republicans risk looking like defenders of a discredited status quo.

So far, Obama hasn't gotten the public opinion bump many Democrats had hoped for. His job approval rating in the first major USA Today-Gallup poll taken after the bill's passage fell 47%, and his disapproval rating hit 50% for the first time in his presidency.

More importantly, 50% of respondents called the reforms a "bad thing," while 47% called them a "good thing." By 2-1, respondents thought the law would make their personal health care situations worse, not better. The "bad thing" rating rose by 10 points over a Gallup survey taken right after the bill's passage.

One possible explanation for the spike is in the days after passage, big companies came out with statements predicting how much more the reforms eventually would cost them. Obama and congressional Democrats pushed back, saying they will be phased in and benefits eventually will outweigh costs in both coverage and deficit reduction.