Tuesday night’s special election in Florida should be a serious scare for Democrats who worry that Obamacare will be a major burden for their party in 2014. Despite recruiting favored candidate Alex Sink, outspending Republicans, and utilizing turnout tools to help motivate reliable voters, Democrats still lost to Republican lobbyist David Jolly—and it wasn’t particularly close…

Special elections don’t necessarily predict the November elections, but this race in a bellwether Florida district that both parties aggressively contested comes as close as possible to a November test run for both parties. Democrats worked to clear the field for Sink, an unsuccessful 2010 gubernatorial nominee, while Republicans missed out on their leading recruits, settling for Jolly, a lobbyist who once worked for Rep. Bill Young, the late congressman whose 13th District vacancy Jolly will fill. Sink outspent Jolly, but the Republican was able to close the financial gap with the help of outside groups. All told, Democrats held a $5.4 million to $4.5 million spending advantage…

One of the key questions in the race was whether a “fix, don’t repeal” message would resonate with voters dissatisfied with the health care law but unwilling to give up on it. The verdict is incomplete, but it’s an early sign the depth of anger over Obamacare.

Republican National Committee chairman Reince Priebus had every reason to gloat Tuesday night over Rep.-elect Jolly.

“His victory shows that voters are looking for representatives who will fight to end the disaster of Obamacare, to get Washington to spend our money responsibly, and to put power in the hands of families and individuals,” Priebus said. “In November, voters all across the country will have the chance to send the same message that Pinellas County voters have sent: Democrats’ policies are not working for America.”

Don’t be surprised to see vulnerable Democrats across the country start distancing themselves from health care reform in a way that Sink did not…

Obama at this point looks like a drag for Democrats in November, just as he consistently has been for Sink.

“Republican special interest groups poured in millions to hold onto a Republican congressional district that they’ve comfortably held for nearly 60 years. Tonight, Republicans fell short of their normal margin in this district because the agenda they are offering voters has a singular focus – that a majority of voters oppose – repealing the Affordable Care Act that would return us to the same old broken health care system,” Wasserman Schultz said in a DNC rapid response statement.

In FL13, if best GOP does is win a close race in a seat they've held for 58yrs it doesn't bode well for making ACA a signature issue.

— Brad Woodhouse (@woodhouseb) March 11, 2014

“Dems should not try to spin this loss,” Paul Begala, a onetime top political aide to former President Bill Clinton, wrote on Twitter. “We have to redouble our efforts for 2014.”…

In fact, the district should have been one of the Democratic Party’s most winnable targets. Of the 37 GOP-held seats that the Cook Political Report ranks as the most vulnerable to Democratic takeover, only 11 are more Democratic-friendly than Florida’s 13th. The district has just a narrow GOP registration edge…

Following Sink’s loss, some Democrats said they’re rethinking their approach to combating the GOP’s Obamacare-centered assault. Sink’s nuanced “fix it, don’t repeal it” message was one that the national Democratic Party is urging many candidates to embrace, but it may have been drowned out by the avalanche of loud Republican attacks.

At a late-morning conservative briefing hosted by the Heritage Foundation, a dozen Republican members of Congress were asked whether they saw Jolly’s win as proof of the decisive poisonous potency of Obamacare. All of them said yes. Only Michele Bachmann dissented in part, saying Obama himself was an even greater issue.

“I was out with some colleagues last night,” said Tennessee Rep. John Duncan,” and when I first heard Mr. Jolly had won the election, I said, ‘Thank you, Obamacare.'”

However, Greenberg offered additional advice. He said Dems should focus mainly on fighting the health care wars to a draw while simultaneously using economic issues to motivate the Dem base, to match GOP success in ginning up the base over the ACA. And he said Dems needed to go up with more ads to counter the massive spending against Obamacare from outside conservative groups — right now…

Greenberg said the Dem failure to turn out their voters in FL-13 – and not opinion on the health law — was the decisive factor. (The First Read crew noted today that turnout in the district was barely more than half that in 2012, and that Dem voters “didn’t show up.”) Greenberg said, if anything, that the closeness of the race (given GOP turnout superiority) indicated that Dem Alex Sink had mostly neutralized Obamacare as an issue, given all the outside GOP ads hammering her over it.

“To me this confirms an even split on the issue when you join it,” Greenberg said. Sink pollster Geoff Garin went even further in a new memo, arguing that Sink’s “keep and fix” message had helped among independents but that low turnout among Dems had doomed her…

“Jobs are the priority, not health care – you need more than that to energize Democrats,” Greenberg said. “It could be the minimum wage. It could be what you’re going to do on jobs. It could be opposing trade agreements that cut jobs. It could be opposing Social Security cuts. These are issues that move Democrats.”

What Democrats need this year is more Obamacare, not less…

To the extent that the new law has not created a groundswell of enthusiasm for Democratic candidates among the law’s intended beneficiaries it is surely in part because…so many of the law’s intended beneficiaries are not being helped by the law. Fully one half of the expansion of health coverage under the law was supposed to occur through the expansion of Medicaid, to cover all people under 138 percent of the poverty line. And in Florida and nearly two dozen other states, that expansion is not happening, thanks to the Supreme Court ruling that made the expansion optional and the opposition of Republican governors and state legislators.

In Florida alone, there are more than 1 million people who were supposed to be covered by the Medicaid expansion but are still uninsured. In Pinellas County, the heart of the 13th Congressional District, there are more than 50,000 people in that coverage gap (the district as a whole had more than 134,000 uninsured in 2011, slightly below average for Florida’s very high rate of uninsured). Yet this basic reality is constantly overlooked in coverage of the law—pundits note that the law is not polling all that well even among the uninsured, as if this some kind of ironic commentary on the law’s failure. No, it’s a commentary on the fact that millions of the uninsured aren’t benefiting from the law, because of the blockage of the Medicaid expansion. Why should they tell pollsters they support it? It’s not doing anything for them.

It’s not clear whether Sink’s weak defense of Obamacare was the key factor, or even a significant factor, in her loss. Political reporters sometimes make too much of national issues in special elections. But there’s no doubt that Sink’s campaign showed the difficulties of the Democrats’ defense of Obamacare. They have to say they want to fix the program because almost nobody (a bare eight percent in the latest Kaiser Foundation survey) wants to keep the law as is. But to fix the aspects of Obamacare that are imposing new burdens on millions of Americans — higher premiums, higher deductibles, a hugely unpopular mandate, and narrower choices of doctors, hospitals, and prescription drugs — Democrats would have to advocate fundamental changes in the law that they have so far steadfastly refused to accept. Get rid of the individual mandate? To do so would rip the heart out of Obamacare, tantamount to repealing it altogether. Many Democrats would rather lose than do that.

So the Florida contest may or may not be a bellwether. But it did lay bare the Democrats’ “fix Obamacare” dilemma. By the time midterm campaigning is at full speed in September and October, Democratic candidates will probably not be able to get away with listing a couple of non-germane tweaks as their program to “fix” Obamacare. If they try, they could pay a high political price. But if they suggest fundamental changes to the law, they’ll run afoul of party orthodoxy and risk losing national Democratic support. It will be just another added cost of the Affordable Care Act.

That brings us to another reason for Dem despair: A Wall Street Journal/NBC News poll released yesterday puts the president’s job approval rating at 41 percent, down two points since January. That’s the lowest it’s ever been. Overall, the national vibe is bad for the president and negative feelings toward Obama are up since last fall, at 44 percent, compared to 41 percent who report positive feelings.

Republicans aren’t winning hearts either. But the poll suggests that the public is coming around to the belief that the GOP should be in charge of the legislature. Slightly more respondents—44 percent—said they now prefer Republican control of Congress to control by Democrats.

Add in the fact that turnout in mid-term elections tends to favor Republicans, and you have a pretty gloomy outlook for Democrats come November. Bad news like we saw today exacerbates this effect. It’s a feedback loop. Between the poor polling and yesterday’s election, I suspect lots of Democratic hearts are starting to, well, sink.

“I talked to a lot of folks on the trail, and I said, if you like your Republican majority in the House, you can keep it.”

Q: Do you agree with that? Do you agree that the Affordable Care Act was not a factor in the Democratic loss in this race — not a major factor — (inaudible)?

MR. CARNEY: Look, let me — let me — let me say a couple things. Tempting as it is, given my background, I am not going to delve too deep into election analysis. But I will note that any fair assessment of the role that the debate about the Affordable Care Act played reaches the conclusion that at best for the Republicans, it was a draw.

“You have to take your medicine at some point.”