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As Barack Obama prepares to say farewell as president tonight, one of the most fragile pieces of his legacy is the Affordable Care Act. Fierce opposition to the health law built up steadily over the last eight years. As NPR's Don Gonyea reports, it was stoked very early in the Obama presidency by something that was at first dismissed by the White House as an early form of fake news.
DON GONYEA, BYLINE: Remember the death panels? In 2009, when the health care law was still being written, it was Sarah Palin who coined that phrase. In a Facebook post, she imagined her elderly parents or her child with Down syndrome standing, quote, "in front of Obama's death panel and being denied care." Conservative op ed pages were on board, talk radio, too. Here's Rush Limbaugh.
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RUSH LIMBAUGH: Sarah Palin has rocked them with that one because she's dead right.
GONYEA: That same summer, Tea Party activists crowded into town hall meetings and shouted down Democratic lawmakers considering supporting the Affordable Care Act.
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UNIDENTIFIED MAN: I have a question.
GONYEA: All the while, Republicans echoed Palin's dire warnings at their own events. Here's Iowa Senator Chuck Grassley.
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CHUCK GRASSLEY: We should not have - we should not have a - we should not have a government program that determines you're going to pull the plug on grandma. Thank you all very much for coming.
GONYEA: As the summer wore on, the president stayed above the fray until the White House realized it was losing control of the story. Anita Dunn was the White House communications director at the time.
ANITA DUNN: At the beginning of the summer of 2009, the White House did not take the attacks as seriously as perhaps we should have simply because they did seem so crazy.
GONYEA: But the president would eventually have to respond. He went on the road. First, a mid-August town hall in Portsmouth, N.H.
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PRESIDENT BARACK OBAMA: Because the way politics works sometimes is that people who want to keep things the way they are will try to scare the heck out of folks. And they'll create boogeymen out there that just aren't real.
GONYEA: And this in Grand Junction, Colo.
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OBAMA: So the notion that somehow I ran for public office or members of Congress are in this so that they can go around pulling the plug on grandma - I mean, when you start making arguments like that, that's simply dishonest.
GONYEA: Obama signed the Affordable Care Act the following spring. Meanwhile, the false claims of death panels would be named the lie of the year by the fact-checking organization PolitiFact. But Anita Dunn says that early disinformation campaign still had a lasting negative effect.
DUNN: One of the hallmarks of the Affordable Care Act has always been that people don't actually know what is in the bill or really realize the benefits they've gotten. And a huge part of that is simply because of the way it was defined early by the opposition.
GONYEA: She says the White House learned from the experience. Rapid response became more of a priority. But there's another lesson from those early Obamacare battles that Ruy Teixeira of the Center for American Progress says the administration and Democrats have been slow to learn - how to talk to non-college white voters, who were once such a key piece of the Democratic base and who are often driven by this core belief.
RUY TEIXEIRA: That the government's up to no good.
GONYEA: The idea of death panels fit right into that narrative, but you can apply it to other issues as well.
TEIXEIRA: You've got to convince them you take their concerns seriously. You're on their side and the other people are not, and here's exactly why.
GONYEA: That was a major weakness for Democrats in the 2016 election. Non-college white voters rallied around Trump and the message that he - and not the Democrats - is on their side. All along, Democrats considered that claim kind of a fake news story of its own. But they still need to figure out how to counter it. Don Gonyea, NPR News, Washington.