President Obama's health care law has helped millions of Americans obtain insurance coverage, prescription-drug discounts and premium rebates — but with only part of the overhaul in place and widespread confusion about what it does, the administration is still struggling to sell it to voters.
In the 2½ years since Mr. Obama signed the Affordable Care Act, the administration has been frenetic in highlighting tangible benefits. On Tuesday, it announced that Americans saved $1 billion from rate increases that never happened but could have if the law didn't force companies to publicly justify any increases.
But the heftiest parts of the law, including a massive Medicaid expansion and the insurance exchanges estimated to cover 40 million uninsured, won't take effect until well after the November election, meaning most Americans aren't seeing major changes.
Even when they are seeing benefits, they don't connect them with the law.
"A lot of people may have noticed their flu shot was free this year, but might not have credited it to the Affordable Care Act, so I think a lot of the effects may have gotten unnoticed," said Tim Jost, a professor at Washington and Lee University who is a specialist on the health care law.
Meanwhile, health care costs continue to rise, complicating matters for the president, who promised that the law would bend the cost curve.
An annual survey released Tuesday by the Kaiser Family Foundation found that family insurance premiums cost $15,745 on average this year, 4 percent higher than last year. While the recession has slowed growth in recent years, premiums have nearly doubled since 2002.
The administration said the increases weren't good but promised better news when the law is fully implemented.
"We certainly aren't happy to see any increase in health insurance premiums, and we look forward to when the provisions of the Affordable Care Act go into effect — which will reduce premiums for American consumers and businesses," said Gary Cohen, who directs the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services.
Polls show that half the country opposes the law, and Mr. Obama didn't mention it in his speech last week at the Democratic National Convention in Charlotte, N.C.
But administration officials, eager to shift public opinion, have tried to tout every benefit and savings estimate.
This summer, they announced that 13 million people received premium rebates from insurers spending more on overhead than the law allows, and pointed to health care plans for 47 million women that now must cover services such as mammograms and HIV screenings without charging co-pays.
Almost 3.1 million young adults have signed up for their parents' health care plans now that insurers can cover children up to age 26.
Later this month, insurers must begin providing patients with an easy-to-understand summary of their benefits and coverage, using a standardized form that has been approved by the administration.
But the effects of the massive overhaul are too small and too poorly understood to dramatically shift public opinion anytime soon, opponents and supporters agree.
"If you try to somehow quantify the overall impact Obamacare will have on American citizens, the percentage of the impact people have felt to date is minuscule," said Michael Franc, vice president for government studies at the conservative Heritage Foundation. "The vast majority of the impact will be felt in the future."
Both sides are convinced that when that time comes, Americans will end up agreeing with them.
Democrats predict that the law will dramatically expand access to health care coverage while scaling back costs, while Republicans say its regulations will damage businesses and bankrupt government.
Given the sheer size of the 1,000-page health care overhaul, educating the public about what is in the law remains a challenge for both sides.
"It's really, really hard to let a voter know exactly what the connection is between some outcome and the source of that outcome," Mr. Franc said. "It's hard sometimes to draw those connections for people — what percentage of [the price of] a glass of beer is taxes and how much of gas prices are profits, versus other things."
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