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Details of Health Care Ruling Could Be Lost on Public

As The New Republic’s Jonathan Cohn notes, the Supreme Court has a wide menu of options for what it might do with President Obama’s health care bill, upon which it is expected to rule on Thursday.

The court could uphold the whole of Mr. Obama’s bill — or strike it in its entirety. Or it could designate portions of it as being unconstitutional while preserving others. And there are even more complicated permutations – the court could rule on one part of the law, but remand others to a lower court.

These shades of gray might make a lot of difference in terms of the policy implications of the Supreme Court’s ruling. A decision that the individual mandate was unconstitutional, for instance, but that everything else deserved to stand – including the penalties the bill institutes for failing to purchase health insurance – would preserve most of the bill’s structure and would represent a decent alternative for its architects.

But the political implications might be different. These nuances could be lost in the court of public opinion.

Whether you hold responsible Mr. Obama and the Democrats for their failure to market the bill effectively to the public, Republicans for highlighting (and perhaps exaggerating) its most unpopular provisions or the news media for focusing more on the sausage-making process and less on the policy substance, there has always been some dissonance in the way the public perceives the health care bill.

The bill is manifestly unpopular when taken as a whole. And opinions about it seem to be quite entrenched. Essentially the entire time since the bill was passed in 2010, about 40 percent of the public has been in favor of the bill, 50 percent opposed, and 10 percent undecided, according to an average of surveys.

And yet, when the public is quizzed about individual elements of the bill, some are relatively popular — although certainly not the individual mandate. A certain percentage of the dissent about it comes from liberals who think the bill did not go far enough in reforming the health care system.

Meanwhile, the level of public knowledge about the bill is relatively low. Many Americans do not know what exactly the bill does, or they have mistaken impressions about it. Dislike of the bill may reflect overall dissatisfaction with the direction of the country — and suspicion about government’s role in making sweeping reforms — as much as anything else.

In fact, a fair number of Americans do not seem to think that the health care bill exists any longer. About a quarter of Americans think the bill has already been repealed, while another quarter aren’t sure if it has been.

The take-away is simply that to the extent there are political implications from the court’s ruling, they are likely to stem from the headlines and not the fine print. If the court strikes the individual mandate while leaving the rest of the bill intact, for instance, Republicans will still have a strong talking point – the Supreme Court has ruled Mr. Obama’s most ambitious policy unconstitutional – even though this might represent a decent policy outcome for Mr. Obama as compared to a more sweeping ruling.

The notion that the court striking any portion of the bill could somehow boomerang to help Democrats politically seems like wishful thinking for Democrats. If the Supreme Court’s popularity is tenuous, it remains more popular than the health care bill. Republicans would also have a new piece of evidence for their claim that Mr. Obama wasted his political capital on the health care bill at the expense of other priorities. To borrow the terms from figure skating, it’s the artistic impression of the ruling that may influence public opinion more than its technical merits.

Nate Silver is the founder and editor in chief of FiveThirtyEight.