If you weren’t already paying attention to the Ohio governor’s race, you should start now. The race between Democrat Rich Cordray and Republican Mike DeWine to replace moderate Republican and Trump foe John Kasich is arguably one of the more consequential midterms this year, but it has so far flown mostly under the national radar.

The 2020 potential similarities are fairly clear, especially with regards to health care access and affordability, easily our nation’s defining generational issue. Across America, the Kaiser Health Tracking Poll finds that 75 percent of citizens support the protections to health coverage included in the Affordable Care Act (ACA); and, of all life expenses, unexpected medical bills were the biggest worry of 38 percent of respondents, well ahead of all other potential day-to-day costs facing individuals. More locally, according to a recent Politico/AARP poll of voters aged 50 and older in Ohio, protections for pre-existing conditions and durable access to Medicaid are considered the state’s most important election year issues, far outpacing issues like trade and immigration.

This is not surprising given Ohio’s ongoing opioid epidemic and the diminishing access to care for the uninsured. And yet, the counties hit hardest by the opioid epidemic voted overwhelmingly for President Donald Trump in 2016. How these Ohioans vote in 2018 could serve as a bellwether for the strength of Democratic messaging moving forward.

Republican Mike DeWine, Ohio’s incumbent attorney general, has repeatedly pledged to ensure protections for preexisting conditions but his record proves otherwise.

Republican Mike DeWine, Ohio’s incumbent attorney general, has repeatedly pledged to ensure protections for pre-existing conditions but his record proves otherwise. First, he joined a lawsuit against the ACA that would have removed these protections for the 4.8 million Ohioans desperately in need of them. This is not just a function of Republican dogma on fiscal conservatism: Allowing those with pre-existing conditions to access health services is one of the most cost-effective elements of contemporary health care.

Yet, DeWine claims his lawsuit is unrelated to the issue of pre-existing conditions, noting his vigorous support for a popular conservative alternative called high-risk pools as a U.S. Senator. Moreover, DeWine claims that his opposition to the ACA is based solely on this belief that the individual mandate is unconstitutional.

Unfortunately, none of this makes much sense. No matter how many times DeWine may have voted in favor of supporting high-risk pools (seven, according to his Twitter account), research suggests this strategy does not work.

Simply put, if you are serious about health care reform, you cannot support coverage for pre-existing conditions while also being religiously opposed to the individual mandate.

If you are serious about healthcare reform, you cannot support coverage for pre-existing conditions while also being religiously opposed to the individual mandate.

DeWine has also repeatedly attacked Medicaid expansion, an issue he used to garner the GOP nomination while sullying his opponent, Lt. Governor Mary Taylor, in the process. Medicaid provided desperately needed coverage to nearly 790,000 Ohioans on the socioeconomic fringe this year. It is a vital program, especially for those contending with the physical, emotional and financial tolls of opioid addiction. Indeed, after passage of expansion, the uninsured rate in Ohio dropped by 45 percent.

That is a staggering accomplishment, particularly for a state where opioids result in close to $9 billion in direct costs and lost productivity annually. In contrast, Medicaid expansion was associated with a $5 billion upfront price tag, which will likely attenuate over time. Any increase in addiction or mental health services, which all states need more of, requires a reimbursement method (and for many people that is Medicaid).

Polls show 91 percent of surveyed Ohioans believe the opioid epidemic is a very serious problem for the state and its future. A clear majority (64 percent) of Ohioans want protections for pre-existing conditions, according to Public Policy Polling surveys, mirroring similar polling across the country. Ditto for the 59 percent of Ohioans who support continued expansion of Medicaid, as observed by a 2017 poll from the American Medical Association.

In this context, DeWine’s chaotic and opportunistic health policy platforms are bad policy and even worse politics.

In contrast, Democrat Rich Cordray, the Obama-appointed head of the Consumer Financial Protection Bureau, believes in strengthening, not weakening, protections for those with pre-existing conditions and endorses continued Medicaid expansion as a balm for the state’s relentless opioid crisis. After all, supporting practical solutions to this crisis requires a reimbursement method to be in place — and for the many suffering from addiction across Ohio and nationwide, that is Medicaid.

Cordray and his running mate Betty Sutton — a key congressional backer of the ACA back in 2010 — understand the ins and outs of health care. Perhaps sensing this, DeWine now says he is for Medicaid expansion. However, even here this endorsement came with a critical qualifier: the imposition of work requirements. These are the same work requirements which a Kentucky Federal Court recently struck down on the grounds that it could result in less coverage for at risk individuals. Physician groups have also gone on the record against work requirements.

Trump is all too happy to change his positions when convenient, equivocating when pressed for details and even lying. We’re seeing similar tactics being used by Mike DeWine now. During the second governor’s debate earlier in October, for example, DeWine noted his unwavering historical support for pre-existing conditions and Medicaid expansion without qualifications, almost daring the viewer to hold him accountable in the process. Is there any doubt we won’t see this same story in 2020?

Ohio is what is known as a purple state, at least as presidential elections go. Although Trump won there in 2016 by a comfortable margin, Obama won the state twice. This is why what happens here will be so interesting. Will a population that cares about health care and opioids vote for someone who has consistently voted against policies that would help address both problems? And if so, what does that say about the ability of Democrats to explain to voters the differences between GOP and Democratic health care platforms? On the other hand, if the Democrats are instead successful, liberals across the country will be armed with a roadmap heading into 2020.