What you need to know about the forces reshaping our industry.


September 26, 2018

Suddenly, Obamacare is all over Democrats' campaign ads. What changed?

Daily Briefing

    By Heather Bell, Managing Editor

    An autumnal chill is (almost) in the air, your favorite TV shows are returning to prime time—and in yet another biannual rite of fall, you're probably seeing a flurry of campaign ads as we enter the final stretch of the midterm Congressional elections.

    If early data are any indication, this year, voters are paying close attention to candidates' health care views—and candidates, particularly Democrats, are making health care and the Affordable Care Act a key issue on the campaign trail. Let's take a closer look.

    Health care top-of-mind for voters

    In almost any poll you look at, health care ranks as a key priority among voters this year.

    A June Kaiser Family Foundation poll showed pre-existing conditions as voters' top health care campaign, with most Democratic and independent voters—and about half of Republicans voters—saying a candidate's position on the issue is either the "single most important factor" or a "very important" factor in their vote.

    Cheat sheets: Health care's most important—and complicated—legal landmarks

    Similarly, a USA TODAY/Suffolk University Poll found that 10% of respondents said health care was the issue most likely to affect their vote—tied with the economy and jobs and second to immigration and border security.

    Health care top-of-mind for candidates

    With those polling numbers in hand, Democratic candidates are making health care a central plank in their campaign platforms. As USA Today's Deirdre Shesgreen and Maureen Groppe write, "Health care ranks as a higher priority for Democrats this year than it did for Republicans when they crusaded against the Affordable Care Act in 2010 and 2014."

    Using data from Kantar Media, Shesgreen and Groppe estimated Democratic Senate candidates and outside groups aired nearly 56,000 health care-related ads between January and July at a total cost of $14 million. (For context, Republicans have spent more than $20 million on ads praising President Trump and the GOP's tax reform law.)

    An analysis by the Wesleyan Media Project highlighted a similar trend, finding more than half of the ads promoting Democratic congressional candidates in August mentioned health care. "About a tenth of the time, the ads mentioned Obamacare specifically," the Washington Post's Philip Bump reports.

    For example, an ad for Sen. Dianne Feinstein (D-Calif.), whose campaign Shesgreen and Groppe write has spent the most money on health care-related ads, states, "I support the Affordable Care Act and voted against all of President Trump's attempts to repeal it."

    Democrats are not shying away from health care, even in states such as Montana that Trump won easily. For example, Montana Sen. Jon Tester (D) has an ad that features a cancer patient accusing Matt Rosendale, Tester's Republican opponent, of making health insurance less affordable when he served as the state's insurance commissioner. In North Dakota, where Trump won by nearly 30 points in 2016, Democratic Sen. Heidi Heitkamp is neck-and-neck in a Senate race against her Republican opponent, Rep. Kevin Cramer—and she is focusing on the ACA and pre-existing conditions. One ad features North Dakota resident Denise Sandvick who has a heart condition and calls out Cramer for voting to repeal the ACA's pre-existing coverage protections. Heitkamp also makes an appearance sharing her status as a breast cancer survivor.

    And some Democratic candidates, such as Dean Phillips, who's challenging Rep. Erik Paulsen (R-Minn.), are even calling for increasing the government's role in health care. "Health care is one of my top priority issues. I drive the truck and talk to people—health care with very few exceptions is on everybody’s mind," Phillips said.

    On the flip side, Republican candidates are honing in their anti-ACA message in parts of the country where Americans are struggling to afford premiums.

    Republican Jim Hagedorn, who's running for a House seat in the Minnesota 1st Congressional District, told the Wall Street Journal's Stephanie Armour and Reid Epstein, "Farmers, a lot of individual people, are getting crushed. The Democrat candidates are talking universal health care, Medicare for all, single payer, socialized medicine. That's not going to fly in this district."

    Early signs suggest Democrats' strategy could work

    While I'm not in a position to predict how the midterms will play out, early data and recent special elections suggest Democrats may have the upper hand in the health care debate this time around.

    In March's special House race in Pennsylvania, Democrat Conor Lamb was victorious in an election where voters cited health care as a major factor, according to Democratic firm Public Policy Polling.  And a recent CNN poll showed Democratic Senate candidates were leading their Republican opponents in Arizona and Tennessee—two places where voters listed health care as their most important issue.

    As Bump writes for the Washington Post, "The short explanation for why health care might help the Democrats this year as opposed to 2010 and 2014 is a simple one: For the first time, the bill seems as though it needs to be defended. Protecting things people like is generally a straightforward electoral winner.

    Learn what the midterm elections do (and don't) mean for health care

    Health policy has emerged as a key source of debate in the impending midterm elections. Download our ready-to-present slides to learn what the elections mean for the future of health policy.

    Download the slide deck

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.