Sen. Ben Cardin has a tough job: He must defend the still-unpopular health reform law and 23 Democratic Senate seats in the 2012 election cycle.

The Maryland Democrat says the heart of the defense is to win back small-business owners and seniors, while at the same time embracing widely popular efforts to modify the law, such as the repeal of the 1099 tax-reporting provision.

Recent polling suggests that the public is nearly evenly divided on the law, with most polls showing a slight majority against it.

Democratic leaders tapped Cardin, along with Ohio progressive Sen. Sherrod Brown, to turn around public opinion on the law.

“America finally joined every other industrial nation to say health care is a right, not a privilege,” said Cardin, who sat down with POLITICO for a wide-ranging interview last week. “We include that in our messaging. But I’d be the first one to acknowledge that that’s not necessarily going to get us the independent voter or senior voter who left us in the midterm elections. But we do package it with the overall accomplishment that eluded presidents and Congresses for years.”

Pressed on why those arguments would result in more votes for Democrats now, when they didn’t in 2010, Cardin said Republicans’ votes for repeal put them on the wrong side of the popular parts of the massive legislation.

“Now they’ve done it. [Republicans] have voted for repeal. So now they’re on record on these issues,” Cardin said.

With the distinctive cadence of speech and twang that marks him as a Baltimore native, Cardin recounted the familiar Affordable Care Act high points: closing the “doughnut hole” for seniors’ prescription drugs;eliminating co-pays for preventive care; covering children with pre-existing conditions; and allowing young adults up to age 26 to remain on their parents’ insurance. But he also revealed tactical, grass-roots politicking he believes will turn the tide.

He said Democrats need to have message discipline and to keep it local. “We’re going block to block,” he said.

A day earlier, Cardin met with a group of Baltimore County seniors who were “not terribly excited” about the law. “By the time I finished the meeting, I’m telling you, I’m confident that the overwhelming majority were in support of the bill,” he said with a touch of pride.

Cardin’s political experience impressed Democratic leaders searching for a messenger: He was first in his class at the University of Maryland law school and has a total of 44 years of political experience in the Maryland Legislature. In the U.S. House, he served on the Ways and Means Committee; and in the Senate, he is a new member of the Finance Committee and its health subcommittee.

As Cardin hosted reporters in his office, clad in shirt sleeves and a striped tie, an aide said that, when it comes to health care, “He’s OK in the weeds.”

Democrats have recognized the political dangers around the health care law, Cardin said, and are trying to address them head-on.

“We should have been very proud of what we did,” Cardin said. “Instead, most members ran away from the health care bill, and those are the ones who lost.”

“We’ve looked at public opinion. We’ve looked at what we stand for as a Democratic Party, and we think there is a very easy way to present the case against repeal,” he said. “Part of it is to connect to those who are the target for political problems: our seniors. We didn’t get as many seniors’ votes in the midterm as we wanted to get. So we think it’s important that seniors understand that if you repeal the health bill, they lose their wellness exam. No co-pays or deductibles for preventive care.

“We think seniors need to know, if you repeal the health bill, Medicare [Part A] solvency is reduced by 12 years,” he said.

There is no debating that the law trims the rate of growth in Medicare spending, which Republicans characterize as “cuts.” Among the hardest thing that Democrats will have to do is convince seniors that the $155 billion in cuts to hospitals, for instance, won’t affect patient care. The administration has argued that along with these reductions will come a transformation to a new delivery system for health care that will improve overall results, while reducing costs.

Citing Congressional Budget Office estimates, Cardin said the law will help reduce the deficit in the long term — a common Democratic talking point.

“I don’t know how you come up with a credible plan to reduce the deficit that, No. 1, adds to the deficit, because you’ve repealed health care. And two, doesn’t let us get control over the fastest-growing entitlement program. Because the only way you can control Medicare and Medicaid costs in a responsible way is to control health care costs,” he said.

“This bill gives us a way to turn the knobs and to use technology and to use intelligent health care policies to bring down health care costs. So for both reasons, that is the deficit [reduction] and job creation.”

Cardin also sought to explain why premiums are going up, in spite of the predicted cost savings, blaming it on the existing flawed approach to providing care.

“Look at health care outcomes,” he said. “Why do we rank so high on infant mortality? Because we don’t have enough clinics in this country, because people use emergency rooms and don’t get preventive care.”

Cardin also talked about his history as a deal maker with Republicans. He shares common ground with GOP senators on how to reform the Medicare payment formula for doctors, which the ACA didn’t do, because of the cost, now estimated at nearly $330 billion.

Told by POLITICO that the No. 2 Republican in the Senate, Jon Kyl of Arizona, has signaled that he doesn’t believe that repealing the sustainable growth rate should necessarily be offset by cuts elsewhere in the federal budget, Cardin said, “I think Sen. Kyl has a point.”

“I don’t think there is any justification at all for continuing the sustainable growth rates, and I have no difficulty repealing it and not trying to find budget offsets,” he told POLITICO. He said providing “stability” on the payment rates could also tip the scales when smart, ambitious students look at career paths. With students considering whether to go to medical school, law school or Wall Street, the current reimbursement model is definitely a deciding factor, Cardin said. He imagined a smart young person might turn away from medicine as a vocation.

“‘Am I going to bet my family’s livelihood or comfort on what Congress may or may not do? I heard they may even shut down government,’” he said.

“So it’s having an impact — the uncertainty — in the health care system. In Medicare, it’s a driving force,” Cardin said — and not a good one.