It's becoming clear that, assuming it passes, Democratic health care reform will be a major issue in the 2010 congressional races. Several prominent Republicans – including Newt Gingrich and Dick Armey - are already advising GOP candidates to call for full repeal of the legislation. Democrats, meanwhile, are expected to campaign on the merits of the bill, hoping voters “warm up” to health care reform by Election Day. Which strategy prevails could all come down to timing.

Major pieces of the legislation – like health insurance exchanges and subsidies for low and middle-income Americans – won't be implemented before 2013. But it's no accident that tucked into the House and Senate bills are provisions to immediately enact some very campaign-ad-friendly benefits of health care reform – benefits that it might be hard for GOP candidates to run against come next fall. The House bill would require insurers to immediately cover reconstructive surgery for children with deformities. It would also immediately prohibit insurance companies from denying coverage based on domestic violence incidents that now are sometimes classified as pre-existing conditions. The Senate bill would immediately prohibit insurers from denying coverage to children with pre-existing conditions. What GOP candidate is going to say these are bad things? After all, repealing the Democrats' health reform bill would mean reversing these changes as well as staving off new unpopular taxes.  (Emphasis added)

But even aside from good talking points, there are other immediate benefits that might actually change the health care landscape by the time Election Day 2010 rolls around. For example, children would be able to stay on their parents' insurance policies until age 26 or 27. Young adults have some of the highest rates on uninsurance, so this change could actually cause a slight uptick in the percentage of Americans with coverage. Ditto for high-risk pools that would be set up immediately to provide coverage for Americans who haven't been able to get insurance because of pre-existing conditions.

Most polls show that the generic idea of Democratic health care reform is not very popular, and Republicans like Armey are arguing this is reason enough to call for repeal of the legislations. Armey recently told the Plum Line's Greg Sargent:

“This has an unusual ability to be repealed, and the public is on that side.” he said. “The Republicans are going to have to prove that they are worthy of their votes.”

For their part, Democrats appear to be hoping this is exactly what happens. They're betting that health care reform will become more popular once it's passed. Here's what the spokesman of the Democratic Senatorial Campaign Committee told Sargent:

“Republicans on the ballot next November who opposed the bill will be in the precarious position of telling voters they plan to rollback landmark health care reform which will have afforded coverage to hundreds of thousands in their state,” DSCC spokesman Eric Schultz emails.

“We absolutely intend to make Republicans look voters in the eye next November and make it clear they want to take affordable health care reform away from them,” Schultz continues, adding that they intend to press the case that “if it was worth filibustering” to Republicans, then surely it's “worth repealing.”

It's worth keeping in mind that neither Armey nor Gingrich officially speak for the Republican Party. Senate Minority Leader Mitch McConnell has so far not said that calling for full repeal of the health reform is a winning 2010 campaign strategy. (It's also very very unlikely Republicans could repeal all of health care reform even if they wanted to.) It's too early to be making definitive predictions about how the 2010 campaigns and elections might take shape, but it's certainly possible health care reform could further divide the GOP – with Tea Party activists shunning Republican candidates who don't call for full repeal. Remember New York's 23rd?

How Democratic and Republican candidates frame health care reform next fall may come down to two things: How quickly Congressional Democrats can pass their legislation and if the Department of Health and Human Services can implement and enforce enough change to the health care system that voters will be able to see and feel it by the next Election Day. (Emphasis added)