Shortly after Barack Obama signed the Affordable Care Act into law in 2010, Sen. Chuck Schumer proudly predicted, “It’s going to become more and more popular. … By November, those who voted for health care will find it an asset, those who voted against it will find it a liability.” Democrats went on to lose 63 seats in the House and six in the Senate that fall. History repeated itself in 2014: Democrats again predicted they would ride health care to midterm victory; again they lost seats, 13 in the House and nine in the Senate.*
Four more years later, Democrats are—surprise, surprise—yet again expressing confidence that the issue of health care will be a political winner for the party this November. The difference this time, however, is that their candidates are actually behaving like they believe it.
The easiest way to tell what a party wants to talk about is to look at what it is paying to talk about. And all cycle long, Democrats running for the House and Senate have been spending more time and money talking about health care than anything else. That might come as a surprise given how much Donald Trump drives the political conversation these days, but the numbers suggest that health care is the big campaign issue hiding in plain sight.
According to the ad trackers at the Wesleyan Media Project, nearly half of all Democratic campaign commercials that have aired since the start of 2017 have mentioned health care, more than twice the share featuring Democrats’ second-most-mentioned policy issue, taxes. That’s night and day from 2010 and 2014, when roughly one in 10 Democratic ads mentioned health care. It’s more difficult to make a direct comparison with ads that mention Trump—Wesleyan tracks policy mentions and attack ads in separate reports, which don’t always neatly overlap—but the most recent data suggest the two aren’t even close: Democrats talked about health care in an even 50 percent of ads that aired from Sept. 1 to Sept. 30, while they mentioned Trump in just 8.3 percent of ads that aired from Sept. 4 to Oct. 1.
Attend a Democratic campaign event between now and Election Day, and you may not hear the candidate talk about Trump. But rest assured, you will hear all about health care. Democratic candidates in races across the country are sharing stories of their own health problems and the financial pain that followed. Constituents are doing the same. In Missouri, where Trump won by 18 points in 2016, Democratic Sen. Claire McCaskill now begins her campaign events by asking anyone with a pre-existing condition to stand up, a request that can bring a majority of the crowd to its feet.
Or consider West Virginia, where Democratic Sen. Joe Manchin—last seen delivering the sole Democratic vote to confirm Brett Kavanaugh—is up for re-election in the heart of Trump country. Eight years ago, Manchin made the jump from the governor’s mansion to the Senate during a special election with the help of an ad where he used a rifle to literally blast a cap-and-trade bill and promised to “repeal the bad parts of Obamacare.” In 2018, Manchin brought out his gun for an ad once again but this time aimed it at a new target: a printout of a lawsuit, backed by his GOP challenger, to strip Obamacare of its protections for pre-existing conditions.
For much of the past two years, Republicans and their ad-makers have focused their energy on other issues. But that has started to change as Election Day nears. According to Wesleyan, the share of GOP House or Senate ads mentioning health care has grown from just 18 percent in the period from January 2017 through July 2018, to 21 percent in August, and then to 28 percent in September—a number approaching the share of GOP congressional ads about health care back in 2010 (32.4 percent), during the rise of the Tea Party.*
So how does a Republican talk about health care today without reminding voters his party spent the better part of a decade promising to repeal and replace Obamacare if only they got the chance? By ignoring what Democrats have done and focusing on what they might do, as this ad from a Paul Ryan–aligned super PAC does to attack Amy McGrath, who is running to unseat GOP Rep. Andy Barr in a battleground district in Kentucky:
Never mind that, as Politico notes, McGrath does not support Medicare for All. (She’s in favor of letting people buy in at the age of 55 or adding a public option.) Even Donald Trump has gotten in on the action, erasing any doubt that this is a concerted effort by his party to reframe the debate. “In practice, the Democratic Party’s so-called Medicare for All would really be Medicare for None,” Trump wrote in a factually challenged op-ed published Wednesday in USA Today. “Under the Democrats’ plan, today’s Medicare would be forced to die.”
You don’t have to strain to hear echoes of the “government takeover” and “death panel” language the GOP used to create fear about Obamacare. The question for November is if voters will still buy into that fear now that so many of them have grown to like, if not love, the law. According to a Fox News poll from last month, a staggering 86 percent of likely voters said it was either “extremely” or “very” important that they cast their ballot for a congressional candidate who shares their views on health care, more than for any of the other topics surveyed, including Trump’s presidency (72 percent) and Kavanaugh’s confirmation (64 percent). And those same respondents were far more likely to say Democrats would do a better job on health care than Republicans, 51 percent to 35 percent. Whether Republicans can dull that advantage between now and Election Day could prove crucial to their bid to keep control of Congress for the next two years.
Regardless of how the issue plays out in the November midterms, though, it’s not about to go away. Progressive groups and candidates are already treating Medicare for All as a litmus test for any Democrat seeking to run for president. Which means that the health care debate of 2018 is just a glimpse of what we’ll be seeing in 2020, and likely beyond.
Correction, Oct. 15, 2018: This post originally misstated how many House seats Republicans picked up in 2014; it was 13, not 12. The post also misstated the share of GOP ads that mentioned health care in 2010; it was 32.4 percent, or slightly more than the 28 percent of GOP ads that mentioned it last month.