As US midterms approach, the issues topping voters’ minds include healthcare, the economy and the judiciary.

On November 6, voters across the United States will head to the ballot box in elections slated as a test for right-wing President Donald Trump.

The midterm elections follow two years of increasing hostility in American politics, during which the Republican Party has controlled a majority in both the Senate and the House of Representatives.

Although the elections will not consider presidential candidates, they will decide on the trajectory of American politics for the next two years. This year, voters will decide on governors, representatives and senators.

Americans will cast their votes for all 435 seats in the House of Representatives, 35 of the 100 seats in the Senate and 39 state and territorial governorships.

For Democrats, the midterms are an opportunity to take back a majority in both congressional chambers in order to stymie Trump’s controversial programmes.

In the House, Democrats would have to gain about two dozen seats to clinch the 218-seat majority. FiveThirtyEight, a statistics website, predicts that Democrats have an 87-percent chance of gaining a majority.

In the Senate, where Republicans currently control 51 of 100 seats, Republicans have a 83-percent chance of maintaining their majority, according to FiveThirtyEight predictions.

Voter enthusiasm is at its highest level for a midterm election in more than two decades, a September report by the Pew Research Institute found. About 61 percent of voters surveyed said they were enthusiastic about this year’s elections. About 72 percent said they will factor in which party controls Congress when casting their vote.

Among the issues toping voters minds are healthcare, the economy, immigration, women’s rights and Supreme Court appointments.

Healthcare

A major Republican victory in the midterms would likely lead to the final nail in the coffin of the Affordable Care Act (known as “Obamacare“), the healthcare law introduced by Trump’s predecessor, Barack Obama.

Although Republicans have so far failed to repeal and replace Obamacare, Congress and Trump have made changes to it.

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Since then, the party has found itself on the defensive in the debate over healthcare.

According to a September Pew report, about 75 percent of voters ranked healthcare as a “very important”. That same report found that Democrats have a wide advantage over Republicans on dealing with healthcare. Fifty-one percent of voters said that the Democratic Party could do a better job dealing with healthcare, while 35 percent said Republicans would do better.

Against that backdrop, healthcare has taken the centre stage in several key races across the US.

According to the political ad tracking firm Kantar Media/CMAG, Democrats have poured $125m on ads focused on healthcare, while Republicans have spent around $50m.

Healthcare is playing a major role in the Senate election in Texas, where a high-profile race between Republican incumbent Senator Ted Cruz and progressive Democratic challenger Beto O’Rourke is taking place.

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Cruz, who played a leading role in shutting down the government in 2013 as a part of an unsuccessful drive to repeal Obamacare, has in the past vowed to repeal “every single word” of the Affordable Care Act.

In response, O’Rourke has pushed back, arguing that Cruz’s claim to support protecting insurance-seekers with pre-existing medical conditions does not line up with his promise to abolish the Affordable Care Act.

Republicans’ backing of a lawsuit crafted to invalidate the Affordable Care Act has also drawn a backlash. In Wisconsin, Democratic gubernatorial candidate Tony Evers, the state education chief, has challenged incumbent Republican Governor Scott Walker to rescind his support for the lawsuit.

Supreme Court appointees

Trump’s nomination of Brett Kavanaugh to the Supreme Court created a whirlwind of controversy. Kavanaugh is accused of sexually assaulting Christine Blasey Ford and other women when they were in the 1980s. Kavanaugh has denied the allegations.

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Although the Republican-led Senate voted to confirm Kavanaugh, the now-Supreme Court justice has become a rallying cry for Democrats before the midterms.

The allegations against Kavanaugh came amid a swell in controversy over sexual harassment and sexual assault as the #MeToo movement continues to gain steam in the US.

Thousands protested against Kavanaugh during his confirmation process [File: Jacquelyn Martin/AP Photo]

It remains unclear how exactly the Kavanaugh controversy may affect the midterm elections, however. Kavanaugh’s appointment moved the court further to the right, giving Trump more of a boost as he continues to hit the campaign trail for his fellow Republicans. Some analysts say, however, that the controversy over Kavanaugh and the way the allegations were handled may galvanise Democratic supporters.

One thing that is clear is that the issue of appointments is on voters’ minds.

Pew, whose survey took place as the Kavanaugh controversy was under way, found that 76 percent of registered voters viewed Supreme Court appointments as a “very important” issue when considering how they will vote on November 6.

Economy

One of Trump’s rally cries at campaign events is often the economy. He regularly boasts about the growth levels, as well as how unemployment rates are at record lows.

The unemployment rate fell to 3.7 percent last month, its lowest in nearly 50 years. But job growth also slowed, some economists attributing this to Hurricane Florence, which hit parts of the East Coast.

Although the US economy is growing, economists worry working-class families may not really see the benefits. It’s only recently that wages started to slightly increase and some say it may not last. There’s also debate on whether it’s the policies of Trump or his predecessor, Barack Obama, or both that have contributed to economic growth.

According to the September Pew report, Republicans and Democrats are about even when voters are asked which party they think is better at dealing with the economy. About 41 percent said Democrats and 40 percent said Republicans, but as Pew noted that is a significant change from about three months ago when Republicans held a nine-point edge over the Democrats on the handling of the economy.

Women’s rights

With Trump facing strong opposition from women’s rights groups and advocates since the outset of his presidency – when millions of women took to the streets worldwide to protest his – women are expected to play a crucial role in deciding the midterms.

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Most of them Democrats, record numbers of women have run and succeeded in primary elections for the US House, US Senate and gubernatorial races in 2018, according to statistics by the Center for American Women and Politics at Rutgers University.

Since the 1980s, women voters have turned out in larger numbers than their male counterparts, but surveys suggest that, in 2018, a larger number of women have found themselves on the Democratic side of the political divide. Men, on the other hand, are divided about evenly between Democrats and Republicans.

A poll recently published by NPR and Marist found that 62 percent of women disapprove of Trump – around half of whom “strongly disapprove”.

Women’s rights advocates have long criticised Trump. During the 2016 presidential elections, a video emerged of Trump boasting that he could grope women by their “p***y” without consent owing to his fame and wealth.

Women chant and raise their signs during a 2017 rally, part of International Women’s Strike NYC, a coalition of dozens of grassroots groups and labour organizations [File: Kathy Willens/AP Photo]

Rights groups and other advocates also point to the administration’s attack on reproductive rights. From reinstating and expanding the Global Gag Rule, which halts US funding to international organisations that offer abortion services or information on the procedure, to appointing anti-abortion rights individuals to high-level posts within the administration, advocates say Trump is waging an “assault” on women’s health.

A Republican victory would potentially allow Trump to appoint even more conservative Supreme Court judges, casting fear over the future of Roe v Wade, the landmark 1973 decision that ruled on the constitutionality of state and federal restrictions on access to abortion.

Newly minted Supreme Court Justice Brett Kavanaugh has so far declined to comment on how he would rule if he were to consider the legality of abortion. In answering a question about Roe v Wade during his confirmation hearings, Kavanaugh said the case is “an important precedent of the Supreme Court that has been reaffirmed many times”.

Immigration

Although Trump proved victorious during the November 2016 presidential elections after a heated campaign targeting immigrants, outrage earlier this year over the administration’s separation of migrant children from their parents has cast a long shadow over the midterms.

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The Trump administration has pushed sweeping immigration reform, taking aim at undocumented immigrants as well as proposing rule changes for those attempting to obtain green cards, welfare and food stamps, among other government benefits.

In August, the president said immigration will be a winning issue for Republicans in the upcoming midterms, accusing Democrats of advocating open borders and turning a blind eye to crimes committed by immigrants.

“I think we’re going to have much more of a red wave than what you’re going to see as a phony blue wave,” Trump said last month. “Blue wave means crime, it means open borders. Not good.”

More recently Trump has ordered troops to the US-Mexico border to intercept a caravan of migrants and asylum seekers heading there, and has floated the idea of ending birthright citizenship.

Democrats hope to rally minorities and young voters against Trump’s harsh immigration policies, while Trump and the Republicans have accused the Democrats of seeking open borders and a free flow of immigrants into the country.

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Several polls conducted over the summer suggest a majority of Americans believe Democrats are more capable of handling immigration-related issues. In July, a Quinnipiac report concluded that 58 percent of Americans disapprove of Trump’s immigration policies, while a similar Reuters poll found that 52 percent did not support the president’s immigration agenda.

Republican voters, however, continue to support the president on immigration, with more than half supporting separating children from their parents on the border.

Impeachment

For Democrats and Republicans alike, the midterms elections will offer a chance to resolve questions around the potential impeachment of Trump.

Talk of impeachment stems from several issues, including accusations that Trump has inappropriately benefited financially from his presidency, behaved with indecency and an investigation into alleged collusion with Russia during the 2016 elections, among others.

In late August, a poll conducted by The Washington Post and ABC found that 60 percent of American voters disapprove of Trump’s performance, while a similar survey by FiveThirtyEight put the disapproval rating just under 54 percent.

Trump speaks during a ‘Make America Great Again’ rally at Landers Center in Southaven, Mississippi [File: Mandel Ngan/AFP]

According to the poll just under half (49 percent) of those surveyed believed Congress should start impeachment proceedings. About 46 percent said they don’t support impeachment. Of those who support impeachment, about 70 percent identified as liberal.

Republicans and groups that support the right-wing party have seized the threat of impeachment to rally their base, urging their supporters to take to the ballot box in November to prevent the president’s potential removal.

Trump’s lawyer, Rudy Giuliani, has stated that the midterms will be about one issue: “impeachment or no impeachment”.

Democratic Representative Al Green, from Texas, brought a pair of impeachment efforts to the House last winter, but both were blocked by a large margin.