Andy Slavitt

Opinion contributor

President Donald Trump and his allies would like the midterms to be a vote you cast based upon dread and anxiety. All his energy and much of the Republican Party's message have centered on playing to what GOP consultants see as your worst fears: A caravan of lepers coming to invade. Innocent men branded as sexual harassers. The government taking away your health care.

And there’s evidence this has worked for them. Film a TV commercial, set it to ominous music with dark shadowy figures, and exploit the biggest fear you can create. The 2010 campaign was about fear of death panels ready to sentence your grandmother to die. Didn't happen. In 2014, the government was going to let Ebola kill usall. That didn’t happen, either. All of this was an offshoot of the Republicans’ original Willie Horton formula in 1988, designed to scare the public into thinking the Democrats were set to parole dangerous criminals.

I’d love to tell you to vote your hopes, not your fears. That’s how we will build a better country.

Medicaid essential for elderly, opioid treatment

But if you are inclined to vote your worst fears, you should vote on the things you really have to fear, not what you’re told to fear. Don’t start with scary commercials but what politicians have actually promised to do if they win. One easy place to look for that is health care.

The Republicans, for example, have proposed shrinking Medicare and Medicaid by $1.5 trillion over 10 years. Chief White House economic adviser Larry Kudlow and Senate Majority Leader Mitch McConnell both recently reiterated the party's desire for such cutbacks.

Now, that’s not an abstract fear. Medicare pays for health care for seniors, and Medicaid is the primary payer for more than six in 10 nursing home residents.

Before Medicare, Medicaid and other help for the elderly, more than half of seniors had no health insurance and 35 percent lived below the poverty level. Growing old couch surfing your relatives or living in your car, unable to afford to care for yourself —now that’s something to fear.

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Many Republicans, with help from Trump, are suing to invalidate the Affordable Care Act and make its consumer protections — guaranteed insurance for pre-existing conditions, a ban on lifetime limits and limits on insurance company profit limitations — illegal. Trump recently allowed states a variety of ways to duck the ACA law and offer insurance that doesn’t cover mental health, cancer treatment, prescriptions or even lengthy hospital stays, and still call it insurance. Should they have the votes,Arizona Senate candidate Martha McSallysays the GOP will still aim for repeal.

Should you fear Trump’s and Republicans' repeated effort to repeal these protections? Consider this: 42 percent of Americans diagnosed with cancer burn through their life savings within two years.

Deaths from drug overdoses are affecting all of us. Sadly, many of us have either been touched directly or know people who have been. Treatment exists for those who can be reached and can afford it, but it's hard to find. Today, a third of all treatment is paid for by Medicaid. Republicans would like to cut that program and require many recipients to showproof that they are working sufficient hours. Some evenpropose a drug test to qualify.

Cutting funding for treatment during an epidemic when seven people are dying every hour of every dayshould scare you. It’s one reason why many across the country, including in red states such as Utah, Nebraska and Idaho, are pushing to expand Medicaid — not cut it.

Real votes and proposals fuel health care fears

These fears of significant cuts to our health care system are all too real because they don’t come from a scary political commercial put together by political consultants, but a multiyear voting record and live proposals from the administration and Republicans in Congress.

A sound defeat of these ideas will not only lessen the fears faced by millions of Americans, it could also usher in reasons for hope. Hope that Trump receives a stinging message that his attempts to gut health care must stop. Hope that we can close the long chapter of trying to repeal the ACA and start working on commonsense solutions to reduce prescription drug costs and insurance premiums. And hope, ultimately, that we can find better, more comprehensive ways to make sure everyone can afford health care.

If Americans vote their fears on Tuesday, it may just work out differently than the fearmongers think.

Andy Slavitt, a member of USA TODAY's Board of Contributors, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt