WASHINGTON—The TV ad Heidi Heitkamp unveiled in August seems unremarkable, even generic.
Heitkamp, a Democrat running for re-election as U.S. senator for North Dakota, introduces a resident, Denise Sandvick, who has heart disease. Sandvick asks a question of Heitkamp’s Republican opponent, congressman Kevin Cramer.
“Mr. Cramer,” she says, looking at the camera, “I don’t know why you voted to let insurance companies go back to denying coverage for pre-existing conditions. But I know Heidi would never do that.”
This is a dramatic shift in how Democrats run for Congress.
In 2010, Democrats passed one of the most important U.S. laws in decades, providing health insurance to millions of people and new health protections to millions of others. Then they talked about the Affordable Care Act as little as possible.
In the two congressional midterm elections following the passage of “Obamacare,” in 2010 and 2014, it was Republican candidates, not Democratic candidates, who tried to make health care an election issue. Obamacare was unpopular, a liability to candidates who voted for it — especially in conservative areas like North Dakota.
That has changed.
For the first time in a decade, Democrats are on the offensive on health care. Republicans, who made “repeal and replace” a central mantra of the past two midterms, are the ones trying to avoid the subject.
President Donald Trump looms over every aspect of the midterms, health care debates included. But Democratic ads are talking about health care much more than they talk directly about the president. A whopping 63 per cent of Democratic House ads in June and July have mentioned health care, versus 38 per cent that have criticized Trump, according to a Wesleyan Media Project analysis.
Just 15 per cent of Republican House ads over that period mentioned health care. Thirty-five per cent positively mentioned Trump.
“Basically what we’re seeing is a return to normal — in that what we saw over the last handful of electoral cycles was what was aberrant,” said Mollyann Brodie, executive director of public opinion and survey research for the Kaiser Family Foundation. “The normal is that Democrats run on health care. It’s always been an issue that’s been of interest to their voters. They’re usually the party that people trust more on the issue.”
The reversal has come as a result of widely unpopular Republican attempts last year to replace Obamacare with their own plans. Many Democratic ads, such as Heitkamp’s, attack Republicans for attempting to scrap popular provisions of the law.
“They have given us an opportunity to explain why their positions are going to hurt regular people,” said Democratic pollster Jason McGrath.
The most popular Obamacare provision is its ban on health insurance companies denying coverage or charging hefty prices to people with “pre-existing” health problems. Republicans’ efforts last year to weaken protections for these people served to make the protections better understood, Jonathan Oberlander, a University of North Carolina professor who studies the politics of health care.
“One of Obamacare’s problems is it’s many things, and Republicans understandably highlighted the unpopular parts. Democrats had difficulties highlighting the popular parts. Well, when the popular parts looked like they might go away, they gained more visibility, and you see that in this election,” he said.
Democrats are not only trying to bash Republicans over their previous votes but to highlight the ongoing threat posed by current Republican repeal efforts.
One version of the Republican plan was thwarted last year by a single vote in the Senate; if Cramer were to beat Heitkamp or Republicans were to make any other Senate gains, the party could well vote again. And in a lawsuit heard in federal court last week, Trump’s administration is joining Republican-led states in arguing that the protections for people with pre-existing conditions are unconstitutional.
In a new ad, Democrat Sen. Joe Manchin, running in Trump-friendly West Virginia, fires a shotgun at the lawsuit.
When Republicans do talk about health care in 2018, they are sometimes talking less about their own positions than about the growing push from the Democratic left for a Canada-style “single-payer” system, in which government would provide health insurance for everyone.
Democrats are focusing on health care without settling on anything close to a unified national message. In liberal areas and some others, some candidates are using the phrase “Medicare for all,” by which some of them mean single-payer. In more conservative areas, leading Democrats are talking only about repelling Republican attacks and making piecemeal improvements to the current system.
Republicans are trying to use the words of the more aggressive Democrats to raise voter concerns about the more cautious Democrats. At recent campaign rallies, Trump has warned, “They want to raid Medicare to pay for socialism.”
“They’re going to ruin your Medicare. Watch. They want to turn America into Venezuela. I don’t think so,” Trump said in Montana last week.
McGrath is the pollster for Ohio Democrat Danny O’Connor, who ran in an August special election in Ohio’s Columbus-area 12th District. O’Connor forcefully rejected “Medicare for all,” saying he was more interested in protecting Obamacare’s Medicaid expansion.
Like Heitkamp, though, O’Connor ran an ad that emphasized his own personal health-care story. Heitkamp spoke of her breast cancer, O’Connor his mother’s breast cancer.
Trump won the district by 11 percentage points in 2016. O’Connor did much better: the special election was so close that no winner has been declared more than a week later.
“Government takeover, single-payer — that’s not where a lot of these swing-district Democrats are. It’s just not where they are,” said McGrath. “And they’ll try very hard to make it seem that way, but voters are I think paying attention here.”
Daniel Dale is the Star’s Washington bureau chief. He covers U.S. politics and current affairs. Follow him on Twitter: @ddale8