Even with Obamacare repeal in the rearview mirror (for now), the defining issue for many voters in 2018 is health care.
No issue has mobilized Democrats more, after Republicans tried to repeal the Affordable Care Act last year. Polling from the Pew Research Center, Kaiser Family Foundation, and others has shown health care is arguably the top issue for voters this year. It has become a staple of Democrats’ campaigns across the country — from progressive enclaves where running on single-payer health care boosts turnout to red-tinted states that voted for Trump, where vulnerable Democrats are leaning into the protections for preexisting conditions embedded in Obamacare.
Republicans seem to recognize the Democratic advantage, twisting themselves in knots to argue that they too support the most popular parts of Obamacare, even though the party’s official position for eight years was that the law must be repealed root and branch with little attention paid to the details. Compounding the matter is a lawsuit, undertaken by 20 Republican-led states and supported in part by the Trump administration, that would overturn the current preexisting conditions protections.
But there have many shades to how health care is playing out in the midterms. Preexisting conditions are the dominant theme, but Medicare-for-all, prescription drugs, and women’s health are also on the ballot this year.
Here are five House campaigns that, taken together, give a full picture of all the ways health care is defining the 2018 midterms — and five more that look just like them.
Obamacare repeal effort’s ripple effects: New Jersey’s Third Congressional District
What’s the district? The New Jersey Third Congressional District, representing the Garden State’s Philadelphia suburbs. The district voted for Donald Trump by 6 points in 2016. Cook Political Report rates it a toss-up.
Who is the Republican? Incumbent Rep. Tom MacArthur, who was first elected in 2014 and won reelection by 20 points in 2016.
Who is the Democrat? Andy Kim, a former White House counterterrorism official under President Barack Obama. He announced his candidacy shortly after the House passed its Obamacare repeal bill in spring 2017.
How health care defines the campaign: MacArthur is the prototypical Republican paying the price for the GOP’s plans to roll back preexisting conditions.
The New Jersey Republican didn’t just vote for the House GOP’s health care bill. He was instrumental in forging a compromise with the archconservative Freedom Caucus to loosen some of the Affordable Care Act’s protections, like essential health benefits, in a way the far right and the more moderate members of the caucus could agree on.
The part of the House bill that gave the states the option to unwind the law’s insurance reforms was literally named the MacArthur amendment. MacArthur was a forceful defender of the bill and his provision, even standing for hours at a town hall to take questions from constituents. He actually left his leadership position in the moderate Tuesday Group over the issue, in a sign of how far out on a limb he went for Obamacare repeal.
Kim directly tied his campaign announcement to MacArthur’s role in trying to repeal Obamacare. His campaign has repeatedly attacked MacArthur because he “wrote a bill to gut protections for people with preexisting conditions.”
MacArthur, like many other Republicans in the midterms, has tried to claim he supports protecting preexisting conditions despite this history. PolitiFact rated the GOP claim that the House bill, including the MacArthur amendment, kept those protections as “mostly false.”
Polls show three-fourths of Americans support keeping Obamacare’s rules in place, and health care is a dominant issue for voters in the midterms. That has made Republicans like MacArthur nervous, but they can’t escape their record.
Another district like this: Michigan’s Sixth Congressional District. Rep. Fred Upton (R-MI) is safer than MacArthur; Cook rates his district Likely Republican. But, like MacArthur, he personally intervened to help the House’s ACA repeal bill get through and his Democratic opponent has honed in on health care.
Washington Republicans recently started spending on Upton’s behalf, a sign he could be more vulnerable than had been believed. If that’s true, health care is the likely culprit.
A Medicare-for-all candidate is on the ballot: Nebraska’s Second Congressional District
What’s the district? Nebraska’s Second Congressional District, representing the Omaha area. The district voted for Donald Trump by 2 points in 2016. Cook rates the race as Lean Republican.
Who is the Republican? Incumbent Rep. Don Bacon, who was first elected in 2016, when he won by just one point.
Who is the Democrat? Kara Eastman, who defeated former Rep. Brad Ashford in the Democratic primary. She was leading an Omaha nonprofit organization before deciding to run for office.
How health care defines the campaign: Eastman’s May primary win was a watershed moment for the left in 2018, when she beat Ashford, a centrist, by running on Medicare-for-all.
But election prognosticators quickly wondered whether Eastman’s platform would be too far to the left for a swing House district in the plains. Republican Super PACs have attacked Eastman repeatedly for supporting single payer, even as she has tried to focus her general election message on Obamacare repeal (which Bacon backed in the House) and preexisting conditions.
But in a surprise last-minute twist, the Progressive Change Campaign Committee and other left-leaning groups are launching a six-figure ad campaign with a 30-second spot featuring a Trump voter who is backing Eastman because she supports Medicare-for-all.
The New York Times/Siena College House poll shows Bacon with a solid lead. A loss for Eastman, after her heartening primary win, would force the left to reckon with how its core issue plays in some parts of America and with how easily it can be attacked by Republicans.
Another district like this: New York’s 24th Congressional District. The quintessential toss-up race. Another Democratic primary upset, where Dana Balter (running on Medicare-for-all) beat the establishment’s pick in the primary to challenge Rep. John Katko (R-NY). Heading into Election Day, Katko, like Bacon, seems to have a significant advantage over his progressive opponent.
An election focused on women’s health: California’s 25th Congressional District
What’s the district? California’s 25th Congressional District, which covers the northern edges of the Los Angeles metropolitan area. The district voted for Hillary Clinton by 7 points in 2016. Cook rates it a toss-up.
Who is the Republican? Incumbent Rep. Steve Knight. He was first elected to Congress in 2014.
Who is the Democrat? Katie Hill, who previously led a nonprofit focused on homelessness in LA.
How health care defines the campaign: Hill has spoken openly about her unplanned pregnancy and her internal debate over whether to get an abortion; the pregnancy ended in a miscarriage. She remains strongly in favor of abortion rights.
Knight, on the other hand, is ferociously anti-abortion, and he has supported restricting abortion access and defunding Planned Parenthood at every opportunity. The pro-abortion rights group NARAL made Knight a target for their 2018 efforts and they are running ads in support of Hill, contrasting her position with Knight’s.
Another district like this: Minnesota’s Second Congressional District. Preexisting conditions — considering those can include pregnancy and domestic violence — are particularly important to women. But women’s health and abortion specifically have been a focal point in a more limited number of races, even in the Year of the Woman.
But NARAL has also gone on the air against Rep. Jason Lewis (R-MN), who is running against Democrat Angie Craig. Lewis opposes abortion; he also once lamented, in his prior role as a radio talk show host, that it was no longer acceptable to call women “sluts.”
Tax cuts for big pharma while doing nothing about drug prices: Ohio’s 14th Congressional District
What’s the district? Ohio’s 14th Congressional District, which covers the northeast corner of the state, east of Cleveland. The district voted for Donald Trump by 12 points in 2016. Cook rates it as Likely Republican, but the University of Virginia’s Center for Politics puts it in the Lean Republican column.
Who is the Republican? Incumbent Rep. David Joyce, who was first elected in 2012. He won reelection in 2016 by 25 points.
Who is the Democrat? Betsy Rader, a civil rights attorney who worked at the Centers for Medicare and Medicaid Services under Obama.
How health care defines the campaign: Rader is attacking Joyce for supporting the House health care bill, and thus bringing back preexisting conditions, but she has also zeroed in on prescription drug prices.
In one 30-second spot, she contrasts her experience at CMS with Joyce’s vote for the Republican tax bill, which featured a big corporate tax cut that benefited top drug makers. “David Joyce: He’s not gonna do anything,” she says. “He takes their money and gives them a big tax cut.”
Drug prices are still a top concern for voters in 2018, a populist issue that crosses party boundaries. Rader is a bit of a long shot, but she is leaning into drug prices and a promise of confronting pharma in a district where she’ll need crossover voters.
Another district like this: Illinois’s Third Congressional District. Much like Rader, Democrat Betsy Dirksen Londrigan is attacking Rep. Rodney Davis (R-IL) over drug prices and linking the issue to the incumbent’s vote for the the tax law.
The rare Republican who voted against Obamacare repeal: Pennsylvania’s First Congressional District
What’s the district? Pennsylvania’s First Congressional District. With the court-mandated redrawing of the state’s districts, the district represents Bucks and Montgomery counties in the southeast corner of the state. Cook rates the race a toss-up.
Who is the Republican? Rep. Brian Fitzpatrick, first elected in the Pennsylvania Eighth in 2016. He is now running in the First District after redistricting, though it covers much of his old seat.
Who is the Democrat? Scott Wallace, a lawyer and former Senate staffer from the area.
How health care defines the campaign: Fitzpatrick was actually one of a handful of Republicans to vote against the House health care bill on the House floor. He cited a variety of concerns, including patient protections and the bill’s expected effect on the opioid crisis.
Democrats have focused narrowly on a few procedural votes that Fitzpatrick took during the House’s Obamacare repeal debate to attack him for undermining the law’s protections for preexisting conditions, despite his “no” vote on the final bill.
Independent fact-checkers found the attacks as unfair, and they shamed Democrats for misleading voters on the issue.
Fitzpatrick also notably voted for the GOP tax bill that repealed Obamacare’s individual mandate, a vote that Democrats argue effectively erases his vote against the earlier health care bill, given the mandate’s centrality to the law.
While the policy truth might be murkier than the Democratic attacks suggest, Fitzpatrick’s experience shows that even Republicans who bucked the party on Obamacare repeal can’t escape the Democratic anger on preexisting conditions.
Another district like this: Washington’s Third Congressional District. Rep. Jaime Herrera Beutler (R-WA) also voted against the House health care bill. But her Democratic opponent, Carolyn Long, has been hammering the issue on the campaign trail, pointing to the multiple votes Beutler took to repeal Obamacare during the Obama administration and campaign contributions the Republican incumbent received from the health care industry.