After Years of Quiet, Democratic Candidates Can’t Stop Talking About Health Care

In June, Sen. Claire McCaskill, D-Mo., asked voters at a big political dinner to stand up if they had a pre-existing health condition.

She had been hearing from voters at town hall meetings that they were worried about health care. “I just thought of it frankly at the podium,” she said. “I was just betting this is not that different from my town halls.”

The room was suddenly filled with standing voters. “Even I was stunned just how few people kept their seats,” she said.

Now, McCaskill asks the question at every event. A few weeks ago, she mentioned the experience to her colleague Joe Donnelly of Indiana, another Democratic senator in a close race for re-election this year. His version — asking coal workers at a Boonville, Indiana, rally how many knew someone with a pre-existing condition — “really moved me,” Donnelly said. It has become a staple of his campaign events, too.

After nearly a decade of playing defense on the issue, Democratic congressional candidates around the country are putting a health care message at the center of their campaigns. After the Republicans’ failed effort to repeal the Affordable Care Act, Democrats have detected a newfound concern that the consumer protections established under the law might go away. And that fear has turned into a potent campaign theme.

More than a quarter of working-age adults have a pre-existing health condition, like asthma, diabetes or cancer, that might have locked them out of the insurance market in the years before Obamacare, according to research from the Kaiser Family Foundation. Surveys show that far more have a friend or family member with a serious medical problem. Because health problems tend to pile up as people age, the older voters who tend to turn out most reliably in midterm elections experience such worry disproportionately.

“I completely can see why they’re excited to be able to talk about this issue again,” said Mollyann Brodie, a senior vice president at Kaiser, who runs the group’s public opinion polling. The foundation’s most recent survey, released last week, found that pre-existing conditions had become the most important health care concern among voters, ranked the most important campaign issue for many of them overall. “I agree with the strategy, based on our polling and everyone else’s polling. It’s a time when it is going to work.”

It is not just red-state Democratic senators who are focusing on pre-existing conditions. The issue is coming up in House races across the country. Tyler Law, a spokesman for the Democratic Congressional Campaign Committee, ticked off districts — in Arkansas, Washington, New Jersey — where it is a major campaign theme. In markets with close races, the committee is running its own advertisements on health care.

“We’re seeing candidates in every single district talking about health care,” he said. “There is nowhere this does not play.”

TJ Cox, a candidate in California’s 21st District, in the state’s Central Valley, said the issue was personal to him. He remembers being pulled aside by a hospital employee while his wife was in labor and told that her C-section would not be covered by his insurance, because she was pregnant when he bought the policy. Fortunately for him, his wife, a physician, had her own coverage.

He also hears about the issue from voters, including one who recently told him about the high cost of medications for hepatitis C, which the man could afford only with the help of insurance. “He was saying literally, ‘I’m glad I got sick now, because before I don’t know what I would have done,'” Cox said. “He was uninsurable.”

Analysis of Kantar Media/CMAG data by the Wesleyan Media Project found that health care was by far the most common subject of Democratic campaign television ads. The researchers’ own description suggests the scale of the reversal. “An astounding 63 percent of pro-Democratic ads for U.S. House discuss health care, and 16 percent contain an explicit statement about being in favor of the Affordable Care Act,” it said in a report published Wednesday. In Senate races, a smaller fraction of pro-Democratic ads mentioned health care, 28 percent, but that was still more than any other subject.

The new emphasis on the issue stands in contrast with Democratic campaign themes of the last four election cycles. In those races, it was Republicans who were using health care as their rallying cry. “Repeal and replace” was the centerpiece of many Republican campaigns for four cycles, and one of the most unifying positions among Republican voters. It was not a coincidence that repealing Obamacare became President Donald Trump’s first legislative priority after taking office. Protection for people with pre-existing conditions was a major part of the Affordable Care Act, but Democrats struggled to find ways to champion the law, which was unpopular and polarizing. When asked, they would defend Obamacare. But they rarely emphasized their support. In 2014, ad research from Wesleyan shows, the vast majority of health care ads were those opposed to the health law.

“I’ll be the first to admit I’m as surprised as anyone to be in this position,” said Brad Woodhouse, the executive director of the health care advocacy group Protect Our Care. Woodhouse worked at the Democratic National Committee when the Affordable Care Act passed in 2010, and saw Democrats struggle to discuss it in the years afterward. “But every poll we take, it’s the issue that’s most important to people.”

The newfound Democratic health care enthusiasm may not translate into victories, of course. Republican campaigns are turning away from health care as a major issue this cycle, planning to pay more attention to other messages like immigration, job creation and attacks on Democrats. When they talk about health care, many candidates are focusing on Democratic efforts to expand public health insurance coverage, not on continued calls to repeal Obamacare.

“People tend to vote with their pocketbooks, and the strong economic performance will be at the forefront of every discussion this fall,” said Jesse Hunt, a spokesman for the National Republican Congressional Committee, adding, “A contrast between single-payer health care and our ideas — a more patient-centered approach — is a debate we fully welcome.”

But some Republicans are sticking to the old anti-Obamacare script. In Missouri, McCaskill’s expected opponent, Josh Hawley, the state attorney general, talks about health care frequently. “I talk about Obamacare and just the broken health care system,” he said, noting that the rising cost of health insurance is one of several factors eroding middle-class security.

Two main changes appear to have turned the tide on health care as an issue. The Republican effort to repeal Obamacare last year made the embattled health law more popular than it has ever been. For the first time, the Affordable Care Act earned the support of a majority of Americans in public polls, a small shift but one that has been durable, even as Congress moved on to a tax overhaul and other issues. Pre-existing condition protections have always been much more popular than the law overall.

The threat of repeal appears to have been particularly galvanizing for Democratic activists, who came out to protest and contact their legislators during the debate.

The second change came more recently, when the Trump administration decided not to defend Obamacare from a lawsuit brought by the Republican attorneys general of 20 states. The lawsuit argues that the entire law should be invalidated as unconstitutional. The Trump administration’s position is that most of the law should remain on the books, but that its protections for people with pre-existing illnesses should be stripped away. Hawley is one of the attorneys general who has signed on to the lawsuit, though he argues that pre-existing conditions protections could be preserved without the Affordable Care Act. Patrick Morrisey, the West Virginia attorney general, has also joined the lawsuit and is running for Senate.

Several Democratic candidates and campaign consultants described the lawsuit as a political gift, because it clarified the contrast between the two parties on an emotionally resonant issue.

“What has changed is all the warning lights are on right now,” Donnelly said.