California is not exactly the epicenter of the controversy surrounding the 2010 health care law. None of the lawsuits that led to the Supreme Court’s decision last month upholding the law came from the West Coast. Unlike so many other governors, the state’s chief executive, Democrat Jerry Brown, has supported the law and plans to implement it. Other issues, particularly the economy, are dominating the political discourse there.

Still, the two national parties and their allies are hoping that the tremors of the debate will be felt in several of the state’s Congressional districts, an unusually large number of which are competitive this year as a result of redistricting. One TV advertisement commissioned by the National Republican Congressional Committee, for example, targets Rep. Lois Capps of Santa Barbara, a Democrat (and former nurse) running for an eighth term in territory that’s largely new to her. Two sisters text one another, complaining that Medicare cuts in the law could be “bad for mom’s hip replacement” and “our family premiums just went up.” One types in that Capps “wants to keep the whole %^#* thing.” The other responds, “Can we repeal Capps???”

Another TV spot, paid for by the Democratic Congressional Campaign Committee, targets another Southern California Congresswoman first elected in 1998 and now running in a redrawn district: Republican Rep. Mary Bono Mack of Palm Springs. The ad, which aired  shortly before Bono Mack joined the House majority this month in voting to repeal the law, stresses the importance of the statute’s preventive care mandates, such as copay-free coverage for breast cancer screenings.

“Your Member of Congress may vote to repeal important health care benefits for everyday Americans,” the narrator says, “but she protected generous health plans for Congress at taxpayer expense.”

The ads are part of a national effort by both sides to rally core supporters and convince swing voters that their position on the health care law will benefit the country. The parties are underscoring the message with recorded phone calls to voters in some districts, mail to supporters and fundraising appeals.

The high court’s decision is being invoked by both sides. The justices ruled, in a 5-4 opinion by Chief Justice John Roberts, that the law’s individual mandate to buy insurance is constitutional because the penalty for those who don’t buy coverage should be considered a tax. The court also found that the penalty for states that do not expand Medicaid, the federal-state program for lower-income people, was excessively coercive; states would have lost all federal matching funds for their existing Medicaid programs if they said no. So the court said states could choose to opt out of the expansion without risking all their Medicaid funds. (The law calls for states to broaden Medicaid so everyone with income below 133 percent of the federal poverty level is eligible; currently, many states do not offer coverage to adults without children unless they are very poor.)

Republicans are using the Supreme Court’s labeling of the individual mandate penalty as a tax to build their argument that Democrats are on a taxpayer-funded spending binge. As one recent NRCC message put it, “Democrats are leaving no doubt about their desire to drive our economy over a cliff in order to get the tax hikes they want to fuel their spending addiction.” Now that the court has ruled, Republicans say their only chance to block the biggest provisions of the law before they take effect in 2014 is to elect a GOP majority for both the House and Senate and put Mitt Romney in the White House.

Democrats are touting the fact that the court found most of the law constitutional and are highlighting the law’s benefits. Part of the thinking behind the efforts is that the number of truly undecided voters is relatively small this year, and so the parties need to motivate voters leaning their way.

“The context of the debate about the bill will be different as a result of the court decision because it was easy for Republicans to say it’s not only going to do bad things, it’s also unconstitutional,” said Robert Blendon, a health policy professor who directs the Harvard Opinion Research Program. “They can’t do that anymore, so they have to focus on primarily the economic argument — that it’s bad for the economy. Democrats will use the bill a bit more than they had to excite their own constituents.”

Reform Is in the Eye of the Beholder

Party and candidate spending in Congressional races is being bolstered more than usual this cycle by independent advocacy groups.

Crossroads GPS, the super PAC created by Bush family political architect Karl Rove and former GOP national Chairman Ed Gillespie, plans to spend millions of dollars on ads like one that recently went after Sen. Jon Tester of Montana, one of the Democrats in tossup races for second terms in the Senate. (He and another, Sen. Claire McCaskill of Missouri, both voted for the law.) The ad said the statute “cuts Medicare spending by $500 billion, gives a board of unelected bureaucrats the power to restrict seniors’ care and raises taxes by a half a trillion dollars. Instead of listening to Montana, Jon Tester supported Obamacare.”

On the Democratic side, a political action committee ad blames Romney for costing people their jobs and health care coverage because of layoffs that took place when Bain Capital, the private equity firm Romney once led, bought their companies. In the ad by Priorities USA Action, a group led by former Obama spokesman Bill Burton, a woman talks about losing her coverage after Bain became her de facto employer in the 1990s. Loris Huffman says she worked at an Ampad paper plant in Indiana for almost 34 years and had two and a half years before qualifying for retirement. “I was suddenly 60 years old. I had no health care and that’s scary,” Huffman says in the spot, which will run initially in five swing states: Colorado, Florida, Ohio, Pennsylvania and Virginia.

Democratic Congressional challengers are also hammering Republican incumbents who voted in favor of the House budget resolutions of the past two years, which the Democrats say would lead to dramatic cuts in Medicare benefits for future retirees. (The budget calls for transforming the program into a voucher-like system that the elderly could spend on private coverage.) The hope is that blocs of middle-aged and older voters who support Romney will back a Democratic Congressional candidate who vows to keep the Medicare system the way it is.

The presidential candidates are using carefully refined messages to appeal to niche constituencies. The Obama re-election campaign, for instance, has produced a one-minute Spanish-language television ad highlighting the benefits of the law for Hispanics. The ads are expected to play in Nevada, Colorado and Florida, which have competitive Congressional races as well. Polling shows that Hispanics favor the law more than other voters.

For both sides, the health care law feeds into a larger narrative. Republicans portray the overhaul as an expensive, heavy-handed government takeover that is indicative of Democrats’ attempts to burden the public with additional regulations and taxes. Democrats say they are standing up for the middle class and those who need help by providing medical coverage, which ultimately could save lives. Although the health care law on its own may not be the most prominent factor in the elections, its portrayal could shape opinions about how different candidates will handle economic challenges and how they view the mission and size of government.  

Public Divided, but Weary

Polls show that the public remains divided over the law, but it has almost never garnered majority support. Most polls have shown a majority in favor of repeal.

In a Kaiser Family Foundation survey conducted of 1,239 adults in the three days after the Supreme Court ruling, June 28-30, about six in 10 Americans were aware that the court had found most of the law constitutional; 47 percent supported the ruling, 43 percent opposed it, and 10 percent were not sure. The views of people were influenced heavily by their party affiliation, as they have been since the debate began.

In a Quinnipiac University poll in early July, 49 percent of registered voters supported repeal and 43 percent opposed it. An average of polls tracked by Real Clear Politics from March 10 to July 14 found 50 percent favoring repeal to 42 percent opposed.

While the opposition remains consistent, the public is more inclined to move on to other issues, especially the economy, according to a survey of 1,000 likely voters conducted for NPR in June by a bipartisan polling team. It  found that 51 percent of voters preferred the argument that Congress should focus on “getting people back to work” and not refighting “the same old health care political battles,” while 44 percent said Congress should focus on efforts to “repeal Obamacare because it is hurting our economy.” That was true even though opponents of the law outnumbered people  approving of it, 48 percent to 43 percent .

Republicans appear confident that focusing on repeal and tying the costs of the law to the bad economy is a winner. The House voted 244-185 to repeal the law three weeks ago, the chamber’s 33rd vote to repeal, limit or defund the law.

For Republicans, the vote was a promise kept to their core supporters who oppose the law. They’re under no illusions that the Senate will take up the bill.

“You necessarily have to do some things for primarily political reasons,” said Rep. Trey Gowdy, a Republican freshman from South Carolina who’s a safe bet for a second term. “Let’s don’t kid ourselves or be naive about it. If something’s not going to become the law and you vote on it anyway, then you have to have a motive other than good legislating.”