Democrats are confidently running on Obamacare for the first time in a decade.

They’ve got a unified message blaming Republicans for “sabotaging” the health care law, leading to a cascade of sky-high insurance premiums that will come just before the November midterm elections. They’re rolling out ads featuring people helped by the law. And Tuesday, they’re starting a campaign to amplify each state’s premium increases — and tie those to GOP decisions.


That’s a big change from four election cycles of reluctance to talk about Obamacare on the stump. During those campaigns, red-state Democrats were often on the defensive, dodging accusations they imposed government-run health care on unwilling Americans, made it impossible for people to keep their doctors and health plans, and caused double-digit premium increases every year.

Now, even those Democrats see Obamacare as a political advantage. The Affordable Care Act has grown significantly more popular. And as Republicans learned last year when they failed to repeal it, the public had scant interest in taking away coverage from millions of Americans, including low-income and vulnerable people on Medicaid. Democrats are also seizing the issue of rising prescription drug prices — another health care cost problem for which the public holds the GOP responsible, according to polls.

While health insurance premiums are still going up — by double-digits, according to the first few preliminary state filings for 2019 — Democrats say the rising costs are now an albatross around Republican necks.

“Democrats need to prosecute the case against the Republican approach to health care,” said Brad Woodhouse, campaign director at Protect Our Care and a longtime Democratic strategist.

They will blame the next round of premium spikes on the GOP because Republicans repealed the individual mandate, eliminated a low-income subsidy, and let people enroll in health plans that don’t have the full range of ACA benefits and patient protections.

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Republicans counter that they are expanding consumer choice and offering more affordable alternatives to the burdensome Obamacare. But they haven’t developed a cohesive message since their repeal efforts collapsed, after years of insistent campaign promises to undo Obamacare. Their best argument so far is that Democrats want to impose a single-payer health system on the country — a progressive idea that Democrats are trying to downplay this year for fear it will hurt them in general election contests.

During the past four election cycles, only the most progressive Democrats touted their Obamacare vote. But this year, even Democrats running in states that President Donald Trump carried in 2016 are touting their health care achievements and the idea of protecting coverage.

“I don’t know that we talked about health care much in 2012,” said Sen. Jon Tester (D-Mont.), referring to the last time he appeared on the ballot. That was just two years after the 2010 Republican wave, when about half of the moderate Democrats lost their races in part because they backed Obamacare. “I mean, truthfully, we talked about pre-existing conditions and lifetime caps and that was about it.”

He’s not the only red-state Democrat owning the health law.

Health care will be a defining difference in North Dakota, where incumbent Democrat Sen. Heidi Heitkamp faces GOP Rep. Kevin Cramer, who backed repeal. In Arkansas, Clarke Tucker, a cancer survivor, says health care is the reason he’s running for Congress. And in New Jersey, Democrat Andy Kim is talking health care as he tries to unseat Rep. Tom MacArthur, who played a key role in finally getting a repeal bill through the House, only to see it die in the Senate.

Health care could be a particularly potent campaign topic in states that expanded Medicaid under Obamacare, and states with large rural populations, such as North Dakota and Montana, which have long struggled to keep their hospitals open in the face of rising costs.

For two years, Tester has been holding round tables with doctors, hospitals and patients, pledging he wants to fix the law but not repeal it.

Heitkamp has taken the same tack and warns that her opponent has voted to repeal Obamacare dozens of times with no replacement ready.

“One of the worst provisions of the bill Kevin Cramer voted for was eliminating the Medicaid expansion,” Heitkamp said. “We would have eliminated health care for thousands and thousands and thousands of people in North Dakota — people with opioid addictions, people whose children are disabled or the elderly in a nursing home. I don’t know how you justify that.”

For his part, Cramer — a House Republican — welcomes the debate over Obamacare.

“If that fight doesn’t come to me, it will come from me. All I would say is, one vote matters, doesn’t it?” he said, referring to the Senate repeal bill falling just one vote short last year. “If we had a different United States junior senator from North Dakota, it would have been repealed and replaced with something that provides more money and more flexibility for people in North Dakota.”

Matt Rosendale, the Montana Republican who is likely to face Tester this fall, says there is no way Democrats can hoist responsibility for Obamacare rate hikes onto the GOP. “I have seen folks’ premiums absolutely skyrocket,” said Rosendale, who happens to be the state official responsible for overseeing the insurance industry.

Still, Republicans don’t have a cohesive answer to their flame-out on repeal — a failure that obliterated a reliable applause line for GOP candidates in every cycle since 2010.

“We’re going to have to figure out a good way to address it because I think a lot of people are frustrated because insurance rates are going to continue to go up,” said Rep. Brett Guthrie (R-Ky.).

He says blame for those rate hikes rests with the Democrats. “It’s the way the law is drafted. You can’t give all these benefits without the insurance rates going up,” he said.

But even Guthrie acknowledges that a wonky conversation about death spirals, insurance actuaries and silver loading — the insurance industry practice of raising the price of “silver-tier” health plans to maximize subsidies — won’t work in a 30-second TV spot. Republicans argue those changes make insurance more affordable.

Complicating matters further for Republicans is the slow growth in the law’s favorability beginning in late 2016, according to a monthly poll conducted by the Kaiser Family Foundation.

In April 2017, when House Republicans were at the peak of their repeal effort, the favorability numbers surpassed the unfavorable numbers for the first time — and have climbed since then. As of last month, 49 percent of all Americans have a favorable view of the law, and 43 percent have an unfavorable view. It’s still not overwhelmingly popular, but the dynamic has changed.

Some conservatives are hoping that the rising premium costs could force the GOP to consider yet another stab at repeal, which would require a complex procedural tool called reconciliation to prevent a Democratic filibuster. But that is essentially a nonstarter, because there aren’t enough Republican votes.

“We right now don’t have the votes to do another reconciliation — that’s just a practical matter. It’s not the sort of thing you say in a stump speech. But we’ve made such great progress turning this [huge] federal government around,” said Sen. Roger Wicker (R-Miss.), referring to broader GOP achievements under the Trump administration. “I think voters are fair and they know the direction that we’ve tried to go and generally succeeded.”