JACKIE JUDD: Good day. This is Health on the Hill, I’m Jackie Judd. Election day is approaching and there is every indication that Republicans will gain a substantial number of seats in the House and several in the Senate. A question we have been returning to the past few weeks is-how does the health care reform law factor into this political debate?

One way to measure that is money. The New York Times reported today that since March opponents of the legislation have spent about a hundred and eight million dollars on advertising, six times the amount spent by supporters of the law.

Here are few examples of what’s out there. American Action Network, which describes itself as a center-right policy institute, has launched dozens of commercials including this one targeting a Democratic incumbent in Michigan’s 7th District.

COMMERCIAL: “Remember this? ‘We have to pass the bill so that you can find out what is in it.’ Now we know what Pelosi and Mark Schauer were hiding: a trillion dollar health care debacle. Billions in new taxes. they cut $500 billion from Medicare for seniors. Then, they spent our money on health insurance for illegal immigrants. In November, tell Congressman Mark Schauer to vote for repeal. American Action Network is responsible for the content of this advertising.”

JACKIE JUDD: In Arizona, Republican Senator John McCain, who really isn’t facing much of a fight, took on his Democratic opponent on health care-among other issues.

COMMERCIAL: “(Music plays, text on screen Rodney Glassman: Music to Obama’s Ears ) Would you have voted in favor of the health care reform package? Most certainly. We need a second stimulus. The reality is the first stimulus package worked. SB1070, I came out the day it was signed and said it was inappropriate. The National Guard is not the answer and neither is building a fence. Being progressive to me means having spent four years working for Congressman Raul  Grijalva and that’s the kind of U.S. senator that I’m going to be in Washington. (music, text on screen: Rodney Glassman, singing the same old Obama tune).”

JACKIE JUDD: Some Democrats are clearly struggling in their approach. West Virginia Senate candidate and Governor Joe Manchin who once said if he gets to Washington he would “fix” the law, now says he never would have voted for it in the first place. Incumbent Earl Pomeroy of North Dakota-a fiscal conservative in a tight race-seems to be issuing a “mea culpa” for his vote on health care in this new commercial.

COMMERCIAL:  “I’d like to introduce myself. I’m not Nancy Pelosi. I’m not Barack Obama. I’m Earl Pomeroy. My opponent says I’ve gone Washington. Well, I have traveled – home to North Dakota every weekend, and eight times to Afghanistan and Iraq for briefings and to support our troops. I know you’re angry with Washington. but we’ll all be angrier next year if they kill the farm bill, privatize Social Security or take away that prescription drug benefit. My opponent would go to Washington, pick the side of special interests and make all that possible. My values are formed right here at Valley City, where I grew up. I know I’ve disappointed you with a vote here and there. But you can always count on the fact that I do what I do for the right reason, or the people of North Dakota. Thanks for the chance. I’m Earl Pomeroy and I approve this message.”

JACKIE JUDD: Here to discuss health care and campaign 2010.Mary Agnes Carey, senior correspondent for Kaiser Health News and Eric Pianin, Washington Editor of The Fiscal Times.  Welcome to you both. If you step back from some of the specifics of the commercials that we just saw, where do you put the Democrats six days out from the election in terms of grappling with what has turned into such a tough issue?

MARY AGNES CAREY: I think that some definitely have decided not to talk about the health care law as part of their campaign. We have seen that. Earl Pomeroy had an earlier ad saying “I stood up to the health insurance companies, I voted for the health reform law.” But here he seems to be looking at the general discontentment with Washington and maybe that is the stronger theme for him as he heads toward his election.

This has been a really tough thing for Democrats. Republicans have had a lot of success with their messages of this is a big law. It is big government. Medicare cuts. You will have to buy insurance. Democrats have struggled more with their message of new consumer protections that kick in now and more protections kicking in 2014. So, it has been I think a lot rougher road than many of them anticipated when the bill was signed into law in March.

ERIC PIANIN: I think that’s exactly right. And if you look at the steady erosion of public support for health care reform going back to March when Congress finally finished up and the president signed the bill, you see that the Republicans have been very effective at chipping away at voter confidence in the plan, raising questions about just how effective it will be, whether it is going to end up raising their premiums, whether they will have real choice in selecting doctors, dozens of uncertainties that they have been able to plant in a lot of voters, especially Republicans and independents.

And if you just look at the polling including polling done by Kaiser Family Foundation over the last four months or so, you see that we have gone from a modest majority in support of it to a modest majority with serious reservations about it.

JACKIE JUDD: A divided electorates, certainly, when they are asked about the bill as a whole, but then when it is broken down into piece parts, there are certainly some parts that are popular.

ERIC PIANIN: I think there is no question about that and a lot of parents are very happy that they will be able to keep their children on their health care policies for several years beyond and there are no longer concerns about preexisting conditions in qualifying for insurance. All that stuff is important but the Republicans have been very clever in sort of taking the health care issue and wrapping it up with a lot of other issues that point to big government, excessive spending.

If you look at a lot of the polls, there is more and more concern about runaway spending, the deficit, as well as unemployment. Probably unemployment continues to be the primary concern, but number two, number three, spending and the deficit, so health care reform is starting to take a lot of knocks because I think people think it is going to be a very costly, complex program that may end up costing them more and giving them less and less personal freedom, which is another big issue the Republicans are pushing.

JACKIE JUDD: You covered Congress for many years. You covered a lot of campaigns along the way, the Democrats controlled the House, they controlled the Senate, they obviously control the White House, why do you think they have been unable to mold a message that is more effective with the electorate?

ERIC PIANIN: I think the responsibility has to go to the White House and I think that Obama and his political advisers were very clever during the campaign and they rode to power in Washington with a very clever message, but I think since then the Republicans have managed to out-flank them on the message. I think that Obama, for whatever reasons, decided to cede a lot of responsibility to Congress in terms of drafting the legislation, coming up with the message.

So it was a very complicated process and over time I think the Republicans with their steady drumbeat: “too expensive invasion of personal rights and individual privacy” has somehow resonated with voters while the Democrats, until recently, have had trouble getting their act together. Now you are seeing a lot of Democrats, veteran Democrats, fleeing for cover and like the Governor of West Virginia who said “yes I was a supporter of it, but now that I know more about it I think I would have voted against it if I had had known what was in the bill.”

JACKIE JUDD: There are, though, a few Democrats who are saying “yes I voted for it,” or if they are not incumbents “yes I support it.” Russ Feingold, of course, in the Midwest, the Senate Democratic candidate in Pennsylvania.

ERIC PIANIN: Ted Strickland, the Governor in Ohio, is standing by his guns as well.

MARY AGNES CAREY: Steve Israel, I believe up in New York, was talking about how he stood up to the oil companies, stood up to the health insurance companies, some Democrats have absolutely perceived this as a winner. But I think to your point about the economy, worsening deficit spending, they might have decided the real message isn’t going to be about health care for this campaign, I’d better shift to the economy, and I think that has been something a lot of the candidates are just wrestling with.

JACKIE JUDD: And Mary Agnes, if voters do vote Republican, whether they are new to the Republican Party or not, what are they expecting from their lawmakers, that elements of the law will be changed? Elements of the law won’t be funded? There will be attempts to repeal. What is the voter expectation?

MARY AGNES CAREY: I am taking a guess here, but looking at various polls and the point you made earlier about when you break it down, people like individual elements, I think voters want to keep what they like. Again, these new consumer protections, keeping your child up to age 26 on your policy, a ban on the lifetime limits, can’t discriminate against a child who is sick, preexisting medical condition, they still have to be covered. They want to keep that, but they might want to dump, get rid of, this individual mandate, the requirements in 2014 that everyone has to have health insurance.

But there is the problem. A lot of health policy analysts will tell you if you don’t have that requirement, people won’t buy insurance until they get sick. The entire foundation of the bill will crumble. You won’t have enough healthy people in the pool to lower the costs. But I think that voters are looking. Some voters absolutely want a complete repeal but I think more voters want to keep what they like and get rid of what they fear will be a problem for them.

JACKIE JUDD: Eric, if Republicans do as well as it now appears that they will, what do you think is the immediate course of action? Is it the de-funding idea, the repeal idea, the repair idea?

ERIC PIANIN: I think that we will definitely see efforts to slow the implementation of the health care bill and conservative Republicans including Paul Ryan who is going to be the new Budget Committee chairman, assuming the Republicans take control of the House, has already talked about doing just that: Making it harder and harder for HHS and the IRS and other federal agencies to do what they have to do to implement the new law. I think that may be scaring some of the advocates of Health Care even more than the legal challenges being waged by Attorney Generals in 20 states around the country.

JACKIE JUDD: Okay, we will see exactly a week from today. Thank you both so much, Eric Pianin, Mary Agnes Carey.