DOYLESTOWN, Pa. — Erika Losse is precisely the kind of person President Obama's signature health-care law is intended to help. She has no health insurance. She relies on her mother to buy her a yearly checkup as a Christmas gift, and she pays out of her own pocket for the rest of her medical care, including $1,250 for a recent ultrasound.

But Losse, 33, a part-time worker at a bagel shop, is no fan of the law, which will require millions of uninsured Americans like herself to get health coverage by 2014. Never mind that Losse, who makes less than $35,000 a year, would likely qualify for subsidized insurance under the law.

"I'm positive I can't afford it," she said.

A Supreme Court ruling on the constitutionality of the health-care law could come as early as today, but even if the Obama administration wins in the nation's highest court, most evidence suggests it has lost miserably in the court of public opinion. National polls have consistently found the health-care law has way more enemies than friends, including a recent New York Times/CBS News poll that found more than two-thirds of Americans hope the court will overturn some or all of it.

That result may stem in large part from more than $200 million in advertising spending by an array of conservative groups, from the U.S. Chamber of Commerce ($27 million) to Karl Rove's Crossroads GPS ($18 million), which includes billionaire Sheldon Adelson among its donors, and the American Action Network ($9 million), founded by Fred V. Malek, an investor and prominent Republican fundraiser.

In all, about $235 million has been spent on ads attacking the law since its passage in March 2010, according to a recent survey by Kantar Media's Campaign Media Analysis Group. Only $69 million has been spent on ads supporting it. Just $700,000 of that comes from the Obama campaign, and none of its ads mentioning the law are currently being broadcast, said Elizabeth Wilner, vice president of the Campaign Media Analysis Group.

"It explains, in a nutshell, why polling shows attitudes about the law to be at best mixed," she said.

On the other side, the 60 Plus Association, a conservative lobbying group for older Americans, has targeted Democratic senators up for re-election with about $10 million in ads warning that under the law, "unaccountable bureaucrats" will be able to "ration care."

A number of Republican candidates have also condemned the law in campaign ads. Ron Gould, who is running in Arizona's 4th Congressional District, released an ad this month in which he blasts a copy of the law to bits with a shotgun.

In contrast, most ad spending in support of the law has come from the Department of Health and Human Services. Appearing mostly on national and cable networks, the agency's ads are bland, explaining aspects of the law.

"Did you know with your health insurance, you may now have some preventive benefits with no co-pays or out-of-pocket costs?" one asks.

In the suburbs of Philadelphia, which, according to the Campaign Media Analysis Group, is one of the top five media markets for ad spending against the health-care law, it is apparent how such messaging is playing out. (The other top markets are Orlando, Fla.; Tampa, Fla.; Pittsburgh; and Denver, all in swing states.)

Nearly everyone said the nation could not afford the law's goal of insuring some 30 million Americans, mostly through a vast expansion of the Medicaid program and federal subsidies to help others who cannot afford to buy coverage on their own. A striking number of people also said the law would limit patient choices and lead to rationing of care — a fear that has been stoked by conservative lawmakers, talk-radio hosts and commentators on networks like Fox, in addition to political-action committees that have run ads attacking the law.

Health plans to pay

rebates of $1.1B

for falling short

WASHINGTON — Millions of consumers and businesses will receive $1.1 billion in rebates this summer from health-insurance plans that failed to meet a requirement of the new health-care law, according to the Health and Human Services Department.

That Affordable Care Act rule requires insurance companies to spend at least 80 percent of subscriber premiums on health-care claims and quality-improvement initiatives. The other 20 percent is left for administrative costs and profits.

Health-insurance plans that don't hit that threshold will send a rebate to consumers to cover the difference.

If the Supreme Court overturns the health-care law, experts say, those checks are unlikely to hit Americans' mailboxes.

In a new report, the Obama administration found that 12.8 million Americans will receive rebates this year, with an average value of $151 per household.

This requirement — known in the law as the "medical loss ratio standard" — came into effect on Jan. 1, 2011. Rebates will go to customers in plans that exceeded the limit last year.

The rebates will go to those in both individual and group plans, with the amount varying greatly by state.

Not all money will flow directly to consumers: For those who receive insurance through their workplace, the health-insurance plan will send a rebate to the employer.

It is then the employer's responsibility to either pass that rebate on to the individual or use it in other ways that may benefit the employee, such as lowering premiums for the next year.

The Washington Post