Health care and the midterms

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With under two weeks until the 2018 midterm elections, health care has emerged as an important theme, shaping the rhetoric of both Democrats and Republicans alike. Eight years ago, Democrats lost their house majority, largely because their key legislative victory, the Patient Protection and Affordable Care Act (ACA) was negatively perceived by voters. Since Republicans have won both chambers of Congress and the White House in 2016, that perception has largely reversed. Voters are increasingly concerned about protecting many of the health care provisions put in place by the ACA, which could imperil Republicans in the 2018 midterms.

Recent polling has shown an increased public concern over protections for people with pre-existing conditions. These provisions of the ACA require insurers to cover people with pre-existing conditions without charging them more. A Kaiser Family Foundation poll showed that for 63% of Americans the most important or very important factor to their vote is a candidate’s position on pre-existing conditions.

Earlier this year, 10 Senate Republicans sponsored a bill (S. 3388) that would force insurers to accept patients with pre-existing conditions. The Ensuring Coverage for Patients with Pre-Existing Conditions Act, Sponsored by Sen. Thom Tillis (R-NC) and co-sponsored by the well-known names of Lamar Alexander (R-TN), Lisa Murkowski (R-AK), Bill Cassidy (R-LA), and Lindsey Graham (R-SC) fell flat after its introduction to Senate due to one major gap: while insurers would have to accept patients with pre-existing conditions, they would not have to cover any services associated with the pre-existing condition. This bill failed to make it out of the Senate and also failed to act as a buffer for Republicans heading into the midterms.

Republicans were further jarred going into the midterms when the Trump Administration backed the Texas v. United States lawsuit, filed by 20 Republican state attorneys general and governors, that would revoke the entire ACA, including protections for those with pre-existing conditions. Sen. Joe Manchin (D-WV), who is up for reelection in a battleground state, has fiercely opposed the lawsuit and has structured his campaign around protecting pre-existing conditions. Manchin released an ad in which he uses a 12-gauge shotgun to shoot through a copy of the lawsuit “that would hurt 800,000 West Virginians.” Manchin’s opponent, Patrick Morrissey, is the current attorney general of West Virginia and part of the lawsuit against the ACA.  

A September Morning Consult + Politico poll found that Democrats hold a 2-1 polling advantage when it comes to whom the public trusts on health care issues and protecting pre-existing conditions. When asked whom registered voters trusted more to protect people from being denied coverage or charged more by insurance companies because of pre-existing conditions, 42% said Democrats while only 20% responded with Republicans. This gap has Democrats confidently running on health care for the first time since the passage of the Affordable Care Act. The messaging is further punctuated by the share of Americans who hold favorable views of the ACA surpassing the share who oppose it.

The shift in the public’s opinion has influenced how politicians have created messages around health care during this midterms. From 2014 to 2018, Republican candidates have reduced their mentions of ACA or Obamacare by nearly 88% while Democratic candidates have increased their positive mentions of the ACA. Further, half of Democratic ads address health care with more than 130,000 ads on health care issues in September alone.

Democrats only need to pick up 23 seats in the House to win the majority, and currently over 60 seats are considered highly competitive. Control of the House could therefore come down, once again, to how the public perceives each party’s handling of health care. To learn more about health care and the midterms, download the health care polling deck from our Presentation Center.