There’s always something of a disconnect between what Washington, DC is obsessed about and what the rest of the country is worried about. In DC, of course, the story is Robert Mueller, Russia and White House chaos. Out in congressional races, however, Democratic candidates aren’t talking about any of those things. Instead, their primary focus is health care; specifically, their criticism of GOP attempts to repeal Obamacare. Ironically, while the passage of Obamacare cost Democrats their House majority in 2010, GOP attempts to repeal Obamacare may help Democrats flip House control in 2018.

While Republicans argue that Americans are going to vote with their pocketbooks this fall (thanks to a growing economy boosted by tax cuts and deregulation), Democrats seem to be betting that health care — costs and access — will be the more salient issue in 2018. In fact, as we saw in the special election in PA-18, Democrat Conor Lamb made the case that many of his constituents are going to have to use their tax cut refund to pay for escalating health care costs. It’s also true that Americans are more emotionally attached to health care than they are to almost any other issue. They may not love the health care system they have today, but they also dislike the idea of government messing with it.

In 2010, of course, voters punished Democrats for messing with the system. But, eight years later, Obamacare is more popular than ever. A February Kaiser Foundation poll found the long-maligned health care law garnering 54 percent approval, including 55 percent among independents. Republicans remain sour on the law, with 78 percent disapproving. In fact, since last summer, Obamacare has enjoyed support from a narrow majority of Americans (50-54 percent). Back in 2016, approval of Obamacare averaged in the low to mid-40 percent range. It’s not clear if this new level of support is due to increased happiness with the law, or if it’s become more popular as GOP attempts to dismantle have intensified.

Moreover, with Democrats no longer in charge in Washington, the issue of health care is now the responsibility of the GOP. Trump has repeatedly pledged to "let Obamacare fail.” Almost every House Republican voted for a bill that would repeal Obamacare. And, Congress won’t help shore up insurers in the exchanges — referred to in DC as Obamacare stabilization — which could lead to insurers jacking up rates. As such, note POLITICO’s Jake Sherman and Anna Palmer: “We’ll see how people feel if [health care] premiums spike.” Plenty of Republicans are worried about the prospect of rate hikes this fall as voters are headed to the voting booth." A Pew poll out this week, found that "health care costs is a top household financial pressure across all income levels. About half (53%) of households earning $100,000 or more a year say it affects their financial situations a lot; about as many (52%) of those earning $30,000 a year or less say the same." 

It’s clear that Democrats see the issue as much more politically potent this year as well. Scroll through the ads Democrats have run in the primaries, or watch their campaign videos, and you’ll find almost all mentioning the “Trump” or “GOP plan” to take away, or raise the cost of health insurance. In her announcement video, Democrat Angie Craig, running against GOP Rep. Jason Lewis in suburban Minneapolis, highlights her family’s challenges in paying the health care bills of her younger sister, and chides Lewis for “his votes to dramatically increase the cost of insurance, and kick millions off health care.”

In Illinois, almost every Democratic candidate running in a competitive House district made health care a part or centerpiece of their campaign message. The top two vote-getters in the crowded Democratic primary in suburban Chicago’s 6th district (held by Republican Pete Roskam) both attacked Trump’s position on health care. Kelly Mazeski, a breast cancer survivor, pledged to “stop Trump’s dangerous plan to hurt millions of people with pre-existing conditions and forces us to pay more for less care.”

Sean Casten, an environmental engineer and winner of the primary, attacked Trump for “gutting health care.”

A nurse and former HHS official under President Obama, Lauren Underwood won the primary for the exurban Chicago-based 14th district currently held by GOP Rep. Randy Hultgren. Her ads featured her in scrubs, where she boasted of her work in “expanding access to care” while "our congressman has not looked out for the folks in the 14th district.” Betsy Dirksen Londrigan, who won the Democratic primary to face Rep. Rodney Davis in the Springfield-based 13th district, talked of her son’s rare and almost fatal infection, arguing that “Trump’s health care plan would have bankrupted us.”

Last week, I met half a dozen Democratic candidates running for GOP-held seats. Every one of them mentioned health care as one of the main reasons for their candidacy. Most mentioned the vote the GOP incumbent had taken last year to repeal Obamacare, framing it as a Republican attempt to “take away health care” from district constituents that will raise the cost of insurance.

Notably, none of the candidates in GOP-leaning districts mentioned the term Obamacare in their ads. The results of the Kaiser Poll gives us a pretty good illustration of why they didn’t. When Kaiser looked at voters who lived in battleground states or districts, 48 percent had a favorable view of Obamacare, and 48 percent had an unfavorable opinion, with slightly more holding a very unfavorable view (33 percent) than a very favorable opinion (29 percent). In other words, while the health care law may garner majority support nationally, it only breaks even in the states and districts that will determine the House/Senate majorities. This is why we should expect to see Democrats run against Trump/GOP actions on health care, rather than promoting or defending the current law.

For their part, Republicans are counting on Democrats to lack this level of discipline on the issue come the fall. Crowded primaries, they argue, are going to push Democrats too far to the left on the issue. Already, we’ve seen at least one candidate in a crowded primary, real estate businessman Paul Kerr running in the open San Diego-based 49th district, highlight his support for Medicare for all.

While Trump and the GOP health bill may not be popular, they argue, neither is Bernie Sanders-style Medicare for all. For example, while some polls have shown growing support of a single-payer or government-run health program, it's also clear that this support is thin and not particularly well-grounded. A Kaiser poll taken last summer found that "the public’s attitudes on single-payer are quite malleable, and some people could be convinced to change their position after hearing typical pro and con arguments that might come up in a national debate. For example, when those who initially say they favor a single-payer or Medicare-for-all plan are asked how they would feel if they heard that such a plan would give the government too much control over health care, about four in ten (21 percent of the public overall) say they would change their mind and would now oppose the plan, pushing total opposition up to 62 percent. Similarly, when this group is told such a plan would require many Americans to pay more in taxes or that it would eliminate or replace the Affordable Care Act, total opposition increases to 60 percent and 53 percent, respectively." In other words, Republicans would be able to play offense on health care (attacking their opponents as supportive of big tax hikes), rather than just playing defense. 

While there is a striking parallel between today’s Democratic criticism of the Republicans attempt to roll-back Obamacare-era reforms and 2010 GOP attacks on Obamacare, it’s also reminiscent of the cap and trade bill fight in 2009. That bill, like the GOP’s health care bill, passed the House, but died in the Senate. And, as with the ultimate fate of the House-passed health care bill of 2017, the cap and trade bill was ultimately defeated by moderate senators from the party in control of the House and White House. While the cap and trade bill didn’t get nearly the media attention as Obamacare did, it was a powerful — and potent — line of attack for the GOP, especially in conservative, rural areas held by Democratic incumbents. The whole “war on coal” attack line didn’t start with Trump; it started with Republicans in the 2010 campaign. Similarly, while the 2017 health care vote may feel like old news to those of us trying to keep up with the daily torrent of salaciousness coming from the White House, it’s anything but dated — or insignificant — for voters.

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