While everyone is focused on impeachment, there’s another issue—an older issue, which hasn’t gone away—that’s nagging the voters. And it could be a sleeper-win for the Democrats next year. Yes, we’re talking about health care. Health care isn’t in the national news today, but it was big in the 2019 election campaigns, and that wasn’t good for the GOP.

What do the 2019 elections tell us about Donald Trump in 2020?

The off-year elections were not good for Republicans. They lost both chambers of the Virginia state legislature and were shellacked in suburban Philadelphia. Most saliently, of the three gubernatorial races—Kentucky, Louisiana, and Mississippi—they lost two. And one of those, Kentucky, was a Democrat pick-up.

So what do these elections portend for 2020? For Donald Trump reelection prospects? Short answer: We don’t know.

For the longer answer, we might recall a little history, looking at these same off-year elections in years past. And if we do, we see that the pattern is that states oftentimes—but not always—zig one way in the off-year election and zag the other way in the presidential election.

For instance, in the 1983 gubernatorial elections, when the same three states—Kentucky, Louisiana, and Mississippi—chose their chief executive, the Democrats swept all three, including a pick-up in the Pelican State. And yet the following year, 1984, President Ronald Reagan was not only reelected, but carried all three of those states.

Skipping ahead three election cycles, we can look at the 1995 gubernatorial elections. In that year, Republicans won two of three, including a Pelican State pick-up. Yet in the year after, 1996, Bill Clinton, running for reelection, carried two of those states.

So what should we conclude? That the voters are fickle? Maybe, but it’s more accurate to say that state issues are oftentimes distinct from national issues. State issues, such as schools and roads, are usually less ideologically fraught than national issues, and so successful gubernatorial candidates tend to be more pragmatic—crusaders are not wanted.

So that’s why one shouldn’t draw any great conclusions about 2020 from the ’19 elections—each ’19 outcome was, in its way, a one-off. (And yes, there was some good news for Republicans; the GOP made minor gains in New Jersey, and Gov. Greg Abbott of Texas notched a win for his anti-tax referendum.)

Of course, in this era when everything seems to polarize, pro or con, around Trump, it’s sorely tempting to attach a future narrative to the ’19 elections, such as, The results prove that Trump is doomed, or Trump will be triumphant. And it is true that since Trump’s approval rating is stuck in the low-to-mid 40s—as of this writing, it’s 43.9—there was an undertow pulling down Republican candidates this year.

In fact, we can reasonably surmise that Trump will have difficulty breaking 50 percent of the popular vote next year. Yet it’s worth remembering that he was elected three years ago with 46.1 percent of the popular vote, and so it’s possible that he could garner a similar percentage next year and win a second time. In fact, by a wide margin, the crowd-sourced betting site PredictIt finds that Trump is the 2020 candidate most likely to win.

Of course, gamblers don’t know the ultimate victor, either—they’re gambling!

Yes, there’s such a thing as the wisdom of crowds, but the course of future events is just as unknown to the crowd as to the individual. How will the impeachment process play out? How will the economy do? Will there be some military conflict somewhere? How ’bout a strong third-party or independent candidate? And to take a trans-Atlantic jaunt, what should we glean from the December 12 victory of Boris Johnson in United Kingdom? Starting with his shock of yellow hair, BoJo is more than a little Trumpian.

Yes, lots of unknown unknowns.

Yet there is one is one particularly scary issue barreling down on the GOP, and it’s a known known.

The Weakest Republican

Of course, the realization that one can’t know the ultimate answer about a future outcome is no excuse for being ignorant of factors that will help shape that future outcome. And so that’s why it’s important to study clues, because even if we can’t know the future, we can know the past—and learn from it. So here’s a clue: Republicans are deeply vulnerable on the health care issue.

This is not a new discovery: Back in August 2017, this author compared Republican attempts to repeal Obamacare to World War One trench warfare; that is, a lot of slogging, and a lot of bleeding, for not much of anything. Most of Obamacare survived that year, and yet the voters didn’t like what Republicans were trying to do, and sent a loud signal of protest; Democrats won big victories in the 2017 off-year elections, including a gubernatorial pick-up in New Jersey. And oh yes, in a special election late that year, the Dems gained a U.S. Senate seat in, of all places, Alabama.

Then came the 2018 midterm elections, and more disappointment for the GOP. And what was the top issue, according to the exit polls? Health care.

Yes, the political dynamic has changed in the decade since Barack Obama signed the Affordable Care Act into law on March 23, 2010. For a while there, Republicans were on the offensive; they ripped into Obamacare and won big in the ’10 and ’14 midterms, as well as in the ’16 presidential.

Yet since then, the healthcare wheel has turned. According to the Kaiser Family Foundation’s monthly tracking poll, Obamacare’s popularity was mostly underwater until 2017, and yet since May of that year, it’s been all positive. Indeed, the latest data, from November 2019, show us that 52 percent of Americans have a favorable view of the program, while 41 percent have a negative view. A wise-guy might put these numbers another way, Obamacare is more popular than Trump.

So it was strange that Kentucky’s soon-to-be-former governor, Republican Matt Bevin. chose to devote much of the last four years fighting Obamacare, including one of its key components, expanded Medicaid. This in a state notable for its poverty, suffering greatly from the opioid epidemic—and most recently, an HIV outbreak tied to intravenous drug use.

(And if we were to draw lessons from Boris Johnson’s victory in Britain, we might have to factor in his position on Britain’s system of national health insurance—he’s 100 percent in favor of it. As he said of his country’s National Health Service during his post-election statement on December 13, “I’ve heard it loud and clear from every corner of the country that the overwhelming priority of the British people now is that we should focus above all on the NHS.” It’s such a concern for ordinary people that it gave Johnson the biggest Tory victory since 1935; the challenge he now faces, as prime minister, is to keep his pledge. If he can, he’ll likely cement those new Conservative voters.)

In fact, back here in the U.S., we should pause to note that Medicaid expansion benefits the working class; that is, the non-working poor already have Medicaid. So we can see: These days, ideological opponents of Medicaid are seeking to deprive potential Republican voters of their health care. Sad! And also, not smart, politically.

Yet Bevin, a businessman by background, has always been a Tea Party ideologue. Indeed, he first came to political prominence in 2014, when he challenged incumbent Sen. Mitch McConnell in the Republican primary. We might pause and ask: Was anyone really supposed to believe that McConnell was some sort of liberal? Bevin lost that challenge, of course, although the following year, he managed to get himself elected governor. And yet even in the Frankfort statehouse, where practicality should have been his guide, Bevin was still the crusading “true believer.” Bad fit.

For insight into how Bevin approached the job of chief executive of a state, we might recall that in August, he asked an audience, “Do you stand with Donald Trump as the president of America or do you stand with The Squad or whatever they call themselves these days? That is the question.” Such a rhetorical question might have been effective if Bevin’s Democrat challenger, Andy Beshear, had, in fact, been a member of the The Squad. But he wasn’t, and so Bevin’s charge went flying off into New York City, or somewhere equally far from the Bluegrass State.

So we can see: Bevin attempted to run a national campaign from the Kentucky statehouse. As such, he flunked the basic test of pragmatism that governors must pass if they are to succeed. Thus Bevin lost in state that Trump had carried by 30 points.

(One might be tempted to dismiss Bevin as just a sincere ideologue ill-suited to his times and to his state, and so that’s why he lost. And yet since the election, Bevin has showed signs of a deep defect in judgement, and perhaps worse than that; perhaps the voters smelled that on him. In fact, in his last days in office, Bevin issued a string of pardons for heinous criminals–including child-rapists and murderers–who showed few, if any, signs of remorse, let alone of rehabilitation or meriting of clemency. To make matters worse, campaign donations might have played a role in the pardons. Yet still, Bevin himself seems to show no clue as to why any of this is wrong–no wonder top Kentucky Republicans have demanded that the U.S. Justice Department look into these pardons.)

Meanwhile, prior to the election, before any of this pardon scandalousness, challenger Beshear had stuck to his signature issue; he made full access to health care his signature issue. And after he won, the new governor-elect was quick to rescind Bevin’s anti-Obamacare directives.

The bottom line seems clear enough: Republican runs on anti-healthcare agenda and loses Republican state. Democrat runs on pro-healthcare agenda and wins Republican state.

The Strongest Democrat

In the meantime, Louisiana proved to be another healthcare election, underscoring, in an opposite way, the importance of gubernatorial leadership.

Democrat John Bel Edwards, just reelected in a state that Trump carried by 20 points, was full-throated about one big thing: He wanted everyone in the Pelican State to have health insurance. In the words of the Baton Rouge Advocate, Edwards “expanded the Medicaid rolls, which Republicans have refused to do elsewhere for years, to cover about half a million working poor adults.”

Admittedly, Edwards is a remarkable Democrat; his vision of health care extends to the unborn. Last May, he signed a pro-life “heartbeat bill,” much to the consternation of Planned Parenthood. Indeed Edwards is even capable of a Trumpian flourish; part of his campaign platform was “putting Louisiana first.”

Yet for Edwards, those were more than just words; he obviously cared about the health of each and every Louisianan. And that’s how a blue man wins in a red state. In the summarizing words of Breitbart News’s Rebecca Mansour, “Louisiana was another health care election. The GOP will continue to lose these elections until they can say these simple words: ‘Access to affordable health care is a right.’”

Louisiana was another health care election. The GOP will continue to lose these elections until they can say these simple words: “Access to affordable health care is a right.” — Rebecca Mansour (@RAMansour) November 17, 2019

A Warning for 2020

Of course, even now, not every Republican will agree with Mansour’s sharp formulation. Yet it does seem that Republican thinking is at least starting to catch up to the changed political reality—that the GOP is now the party of the working and middle class. That is, the poor have always been Democrats, and now the rich, too, are Democrats, and so Republicans need to focus on the votes they can get—the folks in the middle.

So that’s why forward-looking Republicans, such as Sens. Josh Hawley and Marco Rubio, are now shrewdly articulating a new “common good” agenda aimed at the middle class; indeed, they are saying what Republicans should have been saying all along: The market should serve people, and not the other way around.

And for Middle America, government protection against the whims of insurance companies is vital; it’s no wonder that a majority of Republicans wish to see guaranteed coverage for those with pre-existing conditions.

For the Republican Party, as it thinks about health care, the basic problem is this: Either you believe everyone should be covered, or you don’t. And if you do believe in universal coverage, then your healthcare plan starts to look a lot like Obamacare; that is, there must be some sort of mechanism for actually delivering insurance coverage.

Of course it is possible to envision a Republican health plan that’s superior to Obamacare. The GOP version could exclude, for instance, abortion and sex-change operations—and could be written to include only citizens. Yet still, to be popular, it would have to concede the bottom line of universal coverage. And it’s this question of universal coverage that’s been flummoxing Republicans for the past decade, because libertarian ideology has gotten in the way of political practicality.

As we have seen, it’s because of ideology that Republican Matt Bevin lost. And it’s because of practicality that Democrat John Bel Edwards won.

So amidst all of the unknowns about 2020, the Republican defeats in Kentucky and Louisiana tell us something about some of the underlying contours of next year’s election—there are some landmines ahead!

Yes, the big national news today is impeachment, and that effort seems to be boomeranging on the Democrats. And yet it’s a long way from now to November 3. Which is to say, the political environment could tumble like a load of laundry in a dryer—over, and over again. That is, nine or so months after the final sputtering of Nancy Pelosi’s impeachment crusade, some different issue(s) could be dominating the national agenda.

In the meantime, Republicans running for all offices next year are well-advised to pay attention to the recent election results, with an eye toward fortifying their position on health care.

Most immediately, Republicans need to wise up—and stop trying to pull down people’s health insurance in the courts, especially when there’s nothing to replace it. That’s been the risk of the ongoing lawsuit against Obamacare filed by a zealous group of Republican state attorneys general. The GOP AGs are seeking to invalidate the law on legal grounds, and they could potentially win.

If so, such a win would be what’s called a “catastrophic success”; that is, a legal victory, but a political defeat. Why? Because as of now, the GOP has no agreed-upon replacement for Obamacare, and so there’s the possibility that in the wake of an anti-Obamacare court ruling, ordinary people would left with no insurance. Most poignantly, those with pre-existing medical conditions—that’s somewhere between 50 and 129 million people—could lose their health insurance. What Republican pol wants to own that problem?

Fortunately for Republicans on the ballot next year, it appears that such a cataclysm can be avoided; a December 18 ruling by the Fifth Circuit Court of Appeals in New Orleans—kicking the case back down to a lower court—seems to suggest that there’s no chance that the anti-Obamacare case will be decided by the Supreme Court in the coming year. Yes, this is an instance where the wheels of justice turn ver-r-r-y slow, and for Republican politicos, that’s a good thing.

Of course, further down the road, the GOP will have to come up with a plausible healthcare policy, ideally one that is compassionate, fiscally responsible, and socially conservative, all at the same time.

After all, if the GOP is to be the party of the working and middle class, it should defend those classes and all their interests—including the obvious interest of health care. A Republican Party that takes care of workers, soldiers, first responders, and their families—that shouldn’t be such a hard concept to grasp.

Why Aren’t the Democrats Running This Man?

Interestingly, on November 25, the two Democrats we’ve been discussing, Beshear and Edwards, co-authored an op-ed in the Washington Post, headlined, punchily, “How Democrats can win, everywhere.”

The two election-winners recalled some of the details of their winning, such as visiting places in their states that were regarded as hostile territory. And among other centrist ideas that they embraced, they both recalled their campaign’s focus on health care: “Families in both Kentucky and Louisiana worried that their health-care coverage and our states’ Medicaid expansions were going to be ripped away by a Republican governor.”

There it is. Swing voters care about health care. A message all Republicans should take to heart, because the Democrats sure have, indeed, as Politico noted on December 13, whenever Democrats get in trouble because of some left-wing bender—in this case, impeachment—they default back to health care. Thus in the face of polls showing the impeachers hitting a brick wall, embattled Democrats across the country are running spots highlighting their position on … you guessed it, health care. So long as the GOP’s healthcare agenda is in the grip of Tea Party libertarians, at least optically, the healthcare issue will be the Dems’ happy place.

Or to put the matter another way, if Republicans really want to make permanent gains with the working- and middle class, they, too, will get on board with a socially conservative healthcare plan, state by state.

Oh, and a final thought: It should, indeed, be a relief to Republicans that Edwards is unique among Democrats. That is, Beshear ran as a moderate, even if we can all reach a judgment on his recent decision to let felons vote), but Edwards seems to count as a moderate conservative.

In fact, Edwards has grasped that the winning political model is slightly to the left on economics and government and slightly to the right on cultural issues. (Once again, as we absorb the possible implications that the recent U.K. elections might have for the U.S., we can observe that this is the same sort of agenda taken up by Boris Johnson–and he won in a landslide.)

Yes, this traditional nationalist-populist view—so in keeping with how ordinary folks see the world—is a winner on both sides of the Atlantic. And yes, not surprisingly, here in the U.S., such a Main Street view is exactly the opposite of elite bicoastal opinion, which tends to be libertarian on both economics (even rich Democrats don’t seem to be any more eager to pay taxes than rich Republicans) and culture.

In other words, were Edwards on the national ticket next year, he really could be competitive in other red states, as he just proved in Louisiana.

Thus Edwards stands out at a time when most Democrats, even in the South, are siding with the national party (and its donors) on life, guns, and cultural issues. And so Edwards—pro-life, pro-gun is by himself; he’s a lonely winner. But still, of course, a winner.

So if Democrats really wanted to win next year, they’d look to Edwards. Why isn’t he a national figure for the Democrats? The answer, of course, is that the Democrats don’t want to win that badly.

In fact, at the Democrat presidential debate in Atlanta on November 20, moderator Rachel Maddow asked the assembled candidates about Edwards specifically: “Is there room in the Democratic Party for someone like him, someone who can win in a deep red state but who does not support abortion rights?” And while none of the candidates said directly, No, there’s no place, neither did any of them say, Yes, there is a place. Instead, those who answered just reiterated their 100-percent support for abortion. The message seems clear enough.

All this is a bit strange because it would, indeed, spell big trouble for the GOP if there were more center-hugging Edwardses on more ballots—including on the national ballot. That is, pro-health, but also, pro-life. But that just isn’t going to happen, not in the national party–the party of Hillary, and Bernie, and AOC. That’s one prediction about 2020 that we can make with confidence.