WASHINGTON — When the health care debate started bubbling up in Congress last year, Ethan Rome jumped straight into the pot, helping to lead a liberal coalition in favor of the bill. Now, the West Hartford native is in the middle of another fight: trying to mold public opinion in favor of the reform law.

It is no easy task. A new poll released on Tuesday showed that public support for the health reform law has dropped over the past month, from a 50 percent favorability rating to 43 percent. The survey, by the nonpartisan Kaiser Family Foundation, found that Americans remain decidedly split and intensely partisan in their views of the measure.

Thirty percent of respondents said they were enthusiastic about the law, while 31 percent said it made them angry. But perhaps most noteworthy: 45 percent said the word “confused” best described their feelings toward the sweeping legislation.

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Ethan Rome: The health care fight goes on (Deirdre Shesgreen)

“The most striking thing about the polling on health care isn’t whether people are for or against it,” said Rome, executive director of Health Care for America Now (HCAN). “It’s that there continues to be lots of people who don’t know enough about it. So that’s our No. 1 job, along with making sure that a pro-reform majority returns to the United States Congress.”

Of course, there’s no shortage of advocacy groups on the opposite side of the debate from Rome, who see it as their No. 1 job to educate the public about health reform and defeat the Democrats who voted for it.

In early August, for example, a new Republican group called Crossroads GPS, which counts GOP strategist Karl Rove as an adviser, launched a blistering $4.5 million ad campaign targeting the health care law, among other Democratic policies. The group currently has ads airing in three states, lambasting Democrats for supporting “Obamacare” and a “big government health care scheme.”

“The ads are aimed at educating concerned citizens about these officials’ support for a wildly unpopular and budget-busting piece of legislation,” said Jonathan Collegio, communications director for Crossroads. The U.S. Chamber of Commerce is also getting into the fray, as are many GOP candidates, some of whom have made repeal of the law a major campaign platform.

Rome joined HCAN in 2009 after years of working in political advocacy. He cut his political teeth at the Connecticut Citizen Action Group, a social justice organization, before working for Democrats in the Connecticut state legislature, including serving as a top aide to then-House Speaker Thomas Ritter in the mid-1990s.

He later moved to Washington, where he spent seven years as director of public affairs for the powerful American Federation of State, County and Municipal Employees. AFSCME, the AFL-CIO, the National Education Association, and the Service Employees International Union are key members and financial backers of HCAN, and those unions helped spur formation of the group. (Other members include MoveOn.org and the NAACP.)

Rome said he jumped at the chance to join HCAN and do health care full-time at the national level. “We had an historic moment and an unprecedented coalition assembled with $50-plus million, and I wanted to be part of that,” Rome said. HCAN was a key player pushing for reform during the congressional debate.

After a bruising and messy debate in Congress, President Obama signed the health overhaul into law in March. But Rome’s job was hardly over. Earlier this summer, Rome and others launched HCAN 2.0, giving the group a new mission: to promote and defend the law, along with the members of Congress who voted for it.

HCAN hired field workers in 14 states to help bolster vulnerable House Democrats, and the Washington headquarters set up a “rapid response” effort to counter what it sees as misinformation about the law. SEIU plans to spend as much as $54 million on TV ads supporting targeted Democrats who voted for the law, and AFSCME is already on the air in key districts.

Even if public opinion is murky, the battle lines in the health care reform debate are fairly clear.  HCAN and other groups have focused on the so-called “early deliverables,” elements of the law that have already or will soon go into effect. Those items include, for example, a provision allowing children up to age 26 to stay on their parents’ health insurance plans and a ban preventing insurance companies from discriminating against kids with pre-existing conditions.

Republicans, for their part, have focused on the individual mandate in the law-the requirement that, come 2014, all Americans will have to purchase health insurance or face paying a penalty.

“The right focuses on the mandate because they perceive it as the most vulnerable part,” noted Drew Altman, president of the Kaiser Family Foundation. Indeed, the Kaiser poll found that 70 percent of the public views the mandate unfavorably, while other provisions of the overhaul are much more popular.

But details of the law are easily lost in the heated political campaigns unfolding across the country, particularly because many voters care more about jobs and the economy than they do about rehashing health care reform.  And indeed, Rome and Collegio both said they were framing health care as part of a much broader debate-using it as one strand in a larger political narrative.

“Health care is at the confluence of major issues of public concern… because it also impacts the deficit, jobs, and the economy,” Collegio said. “At a time when we are running trillion-dollar deficits, politicians in Washington passed another multi-trillion entitlement program.”

From Rome’s perspective, health care is part of a larger fight about who’s fighting for the little guy and who is standing up for special interests. Democrats “have taken the side of their constituents and are fighting for a better America. versus [Republicans] who have taken the side of big corporations and the super rich, whether it be on health care, Wall Street reform, or big oil.”

Altman said these competing strategies make sense politically, but they may not do much to sway public opinion about the law or clear up misinformation. He said despite the millions of dollars being spent on ads mentioning health care, these efforts are unlikely to have a major impact on who wins control of the House and Senate come November.

“One side can’t afford to have the other side go unresponded to,” Altman said. “You can’t stop that train. But I think that kind of plays to a draw.”

Altman said the reason so many voters are still confused about health reform is that “misinformation and spin” were such a fundamental part of the initial legislative debate. That hasn’t faded, and Altman doesn’t expect it to until the law is fully in place several years down the road.

“We are still moving through a period where the law is a mystery to people, when they’re reacting to a philosophical debate about the law,” he said. “The real test of law will come in a few years, when people see it, touch it, and experience how it actually affects them in their own lives …. That’s when the verdict will be clear.”

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