EnfieldJoe Courtney held up the poster-sized chart and pointed to the numbers printed in purple: 7,700 seniors in his Eastern Connecticut district got a discount on their prescription drug payments last year, thanks to federal health reform. That included 530 seniors from Enfield, where he had come to chat at the senior center, 143 in neighboring Suffield and hundreds more in several other towns listed on the chart.

“This chart shows that there is improvement that’s happening to the system,” the congressman told the audience of 50 or so seniors. He noted that the health reform law is phasing out the Medicare “doughnut hole” that requires seniors to pay for drugs out-of-pocket once their plan has covered a certain amount, but he added that it will take time before all their costs are gone.

Courtney health reform

Courtney and his chart showing how many seniors in his district got drug discounts from the health reform law

“I’m not going to sit here and do a victory dance in the end zone like a football player spiking the football saying the problems are all gone for everybody,” Courtney said. “We’re not at that point.”

If this were a re-election speech, it wasn’t much of a rousing argument. But Courtney has been on a different sort of campaign: pointing out the benefits of the controversial Patient Protection and Affordable Care Act.

The third-term congressman from Vernon hasn’t missed many chances to tout the upsides of a law that many of his fellow Democrats have not gone out of their way to promote. Courtney brought a primary care doctor to town hall meetings last year to talk about patients whose cancers were discovered because of free wellness visits that Medicare now covers because of health reform. He’s delivered floor speeches to point out what he considers positive developments from the law, about which Americans remain divided, according to national surveys.

After the law passed, Courtney remained a vocal supporter of health reform “at a time when a lot of other people were kind of running away from it,” said Dr. Robert McLean, a New Haven internist and rheumatologist who serves as governor of the American College of Physicians’ Connecticut chapter.

The group, which represents internists, named Courtney legislator of the year last fall “to recognize his willingness to be such a vocal supporter of health reform efforts,” McLean said.

Courtney said his continued talk about health reform is a way to analyze what was and wasn’t true in the contentious debates that took place at town hall meetings across the country when Congress debated the issue in 2009, when he said seniors were subjected to “some of the most scurrilous, misleading claims.” He likes to point to what he calls “real data,” like the numbers on his chart showing how many seniors in various towns got discounts on prescription drugs, or the story of a community health center in Windham that benefited from funds in the health reform law.

“To me, those town-by-town numbers are exactly what Tip O’Neill would tell any member of Congress to go out and talk about,” Courtney said, referring to the former Speaker of the House known for declaring that all politics is local. “Because I truly believe that when you localize information such as the prescription drug benefits, the health center in Windham, which just cut a ribbon the other day, and tie it to the health care reform law, that’s just smart representation.”

Not everyone agrees with Courtney’s assessment of the law, or his reasons for touting it. Daria Novak, a Madison Republican running for the 2nd District Congressional seat, said she hears from people in the district with concerns about health reform, particularly business owners who are unsure about its impact and wary about hiring while they’re uncertain.

“My guess is the reason that Congressman Courtney is talking about this issue so much is that the people in the 2nd District are very upset about Obamacare,” she said. “I believe that Congressman Courtney is trying to defend himself and justify why he voted for this bill.”

Like Novak, Republican candidate Christopher Coutu, a state representative from Norwich, favors repealing health reform. His campaign manager, Chris Covucci, said the law will lead to cuts in Medicare spending and the Department of Defense, which could hurt the region’s defense industry and lead to military base closings, taking away jobs.

“Joe Courtney has lost sight of how to grow jobs in Connecticut,” Covucci said. “And ultimately, it will be jobs, not the government, that provide health care and stability for working families.”

And Novak said that Courtney will have little choice but to talk about health reform if she wins the Republican nomination.

“[Courtney] will be talking about this because we are going to bring the issue up,” she said.

A campaign issue?

In an election year expected to focus largely on the economy, will other candidates follow Courtney’s lead as the elections approach, or keep quiet about health reform?

Norman J. Ornstein, a resident scholar at the conservative American Enterprise Institute, said certain elected officials will be happy to talk about health reform: Republicans in safe districts, where the law is a rallying cry and politicians can pledge to repeal and replace it, and some Democrats in districts where it will generate positive feedback.

But Ornstein predicted that Republicans in contested districts will likely avoid talking about the law because they don’t want people to ask what they’d replace it with. And some Democrats will likely be reluctant to address it for other reasons.

“One, because we know it’s met with at best lukewarm approval,” he said. “Two, because I think where Democrats talk about health, they’d much rather talk about Paul Ryan’s Medicare plan.”

Congress’ approval rating hovers around 10 percent, making it less potent for incumbents to tout their accomplishments than to accuse the other side of threatening to destroy something popular, Ornstein said — in this case, Republican Rep. Paul Ryan’s plan to shift Medicare from an entitlement in which the government pays the medical bills to one in which the government gives seniors money to buy insurance.

For Democrats that do campaign on health reform, Ornstein said they’ll likely focus on the elements of the law that have proven popular and what Republicans would do if they repealed the measure. Those include a provision allowing young people to remain on their parents’ health insurance until turning 26 and requirements that insurers offer coverage to people with pre-existing conditions.

Courtney noted that the law does not seem to carry the same emotional resonance as it did in 2009, when Congress was debating proposals and town hall meetings drew protests and people scared that it would hurt Medicare.

The tone at Courtney’s appearance last week in Enfield, the site of a contentious 2009 meeting, was decidedly calmer. People in the audience listened as Courtney and Christie Hager, regional director for the U.S. Department of Health and Human Services, spoke about health reform and Medicare. Some audience members asked about Medicare coverage and how the U.S. Supreme Court or a new presidential administration could affect health reform. The most impassioned exchanges involved why Medicare doesn’t cover dental care, or disparities between Medicare Advantage plans and traditional Medicare.

The difference in tone doesn’t mean everyone is sold on the law, Courtney said. “There’s still, I think, a lot of concern people have,” he said. “The jury’s still out for a lot of people, but it does not have the same emotional response that it did in 2009.”

That could change this summer, he added, when the U.S. Supreme Court is expected to rule on a challenge to the law’s mandate that most Americans have health insurance.

The root of his interest

Asked about the root of his interest in health care, Courtney, a lawyer, noted that he had to purchase insurance when he was a small employer. He had a brother who died of cancer at 26. Although his brother had health insurance, Courtney said the experience taught him that “we all have clay feet and that not having a system that provides that basic level of security is just really unacceptable for a country.”

His wife, Audrey, is a nurse practitioner who gives him exposure to a more expert viewpoint. And he says the year he spent in England during college gave him a chance to see how another system worked.

“But to me, at the end of the day, this is really an issue about justice,” he said. “It really is about whether or not a society or a country like ours can have some basic level of provision for something that we all need as humans.”

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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