Democrats’ healthcare focus has propelled it to ‘the top of the issue list in national polls’ as Republicans seek to change the subject

As an example of having your cake and eating it, the four-term Republican congressman struggling to fend off a challenge from a political novice offered a masterly contortion.

Kevin Yoder, under siege in an eastern Kansas district, was asked at a public debate this week what the greatest threat facing the United States is today. His opponent, a Democratic newcomer with a clear lead in the polls, said it is a crisis of affordable healthcare that will harm generations to come.

Then came Yoder’s turn. He too thought it was healthcare. Particularly the opioid epidemic. And that, he said, was being made worse by America’s open borders permitting illegal drugs into the country.

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“A lot of these drugs are coming across our south-western border,” he said. “My opponent’s open borders proposals to let the caravan in, to let drug traffickers and human traffickers in, that brings a lot of drugs into our country.”

In a single answer, Yoder embraced one of the Democrats most effective political weapons across the midwest and beyond this election season – fears over access to healthcare – but then shifted the focus to the issue the GOP hopes will counter it: immigration.

For Yoder, at least, it does not appear to be working.

Facebook Twitter Pinterest Republican congressman Kevin Yoder has said America’s opioid epidemic is being worsened by drugs coming across the southern border. Photograph: Charlie Riedel/AP

Where Republicans once thought attacks on Barack Obama’s healthcare reforms were good fodder for their political campaigns, now they find themselves on the defensive over the issue in key seats. Candidates for Congress, state governor and local offices are hurting their GOP opponents with attacks on their voting records in opposing Obamacare, saying they threaten the protection the law offers such as those for people with pre-existing conditions.

Republican attempts to shift the debate to fears about illegal immigration, which polls show is the most common concern among the party’s voters, have been bolstered in the last week of the midterm campaign by Donald Trump’s dispatch of thousands of troops to the Mexican border, ostensibly to protect it from a caravan of migrant Central Americans who are several weeks away, and his threat to unilaterally overturn the right to citizenship for everyone born in the US, a move that is probably unconstitutional.

A Pew Research Center poll this month put illegal immigration as the highest-ranked issue among national problems for Republican electors, although that does not mean it is the single most important factor in deciding who to vote for. At the same time, drug addiction was in second place and more than half of Republicans put affordability of healthcare on their list of the country’s biggest problems.

Another poll, by the Kaiser Family Foundation, found immigration was the single most important issue among only 25% of Republicans in shaping how they vote. Among all voters, healthcare came out on top.

Drew Altman, the president of the Kaiser Family Foundation, recently wrote that Democrats’ focus on healthcare has propelled it to “the top of the issue list in national polls, even ahead of the economy and jobs”.

Meanwhile, immigration has not only defined differences between Republicans and Democrats but opened up divisions within the GOP itself. On the back foot in an increasingly liberal district, Yoder has attempted to tread a careful line that has put him at odds with the president and his party’s candidate for Kansas governor, Kris Kobach.

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Kobach, the Kansas secretary of state, is continuing to hit the issue hard while fending off attacks on his record in opposing Obamacare.

At a recent rally with Trump in Topeka, Kobach told the crowd that undocumented immigrants are a drain on the state’s resources and that “it’s time to put Kansans first, not illegal aliens”.

“We’ve worked on a number of things, but the most important is stopping illegal immigration,” he said to huge cheers.

Facebook Twitter Pinterest Claire McCaskill has criticized her rival, Josh Hawley, for supporting efforts to scrap Obamacare. Photograph: Charlie Riedel/AP

Kobach has long targeted immigrants. He headed Trump’s committee investigating what proved to be an illusory problem of foreigners voting illegally, and backed a state law requiring voters to prove their citizenship that was struck down as unconstitutional. But it does not appear to have delivered the support he hoped. He is struggling against his Democratic opponent, Laura Kelly, in a state Trump won by 20 points in 2016.

Yoder stayed away from the Trump rally in Topeka as he attempted to straddle the divide by saying that he supports the president’s plan for a border wall and the administration’s aggressive stance on illegal immigration, but that he also backed Democratic demands that those brought to the US as children be protected from deportation. Yoder also objected to migrant families being broken up with children separated from their parents until denunciations on Fox News forced him to retreat. Earlier this week, he dodged a question about whether Trump is right to threaten citizenship as a birthright.

So far, the balancing act is not paying off for Yoder. Polls put him behind his opponent, Sharice Davids, who has focused much of her campaign on healthcare.

In October Obama’s former health secretary and former Kansas governor, Kathleen Sebelius, appeared alongside Davids at a rally to preserve Obamacare reforms and focus attention on Republican attempts to dismantle key parts of it.

In neighboring Missouri, the Democratic senator Claire McCaskill has built the fight to save her seat around attacking the support of her Republican rival, Josh Hawley, the state’s attorney general, for scrapping Obamacare. Hawley joined the slew of GOP state attorney generals who jumped on the political bandwagon of filing lawsuits against the Affordable Care Act. That move was more popular then than now.

McCaskill has rebranded her campaign “Your Health Care, Your Vote” as she accuses Hawley of trying “to remove healthcare protections from nearly 2.5 million Missourians with pre-existing conditions, increase the cost of prescription drugs for some seniors and make it harder for Missourians to afford health insurance”.

It’s not clear if it will pay off for McCaskill but a similar strategy appears to have proved effective for Senator Joe Manchin of West Virginia, another Democrat thought vulnerable because Trump won his state by a bigger margin than any other two years ago.

Manchin looks increasingly secure after hitting his opponent, the state attorney general, Patrick Morrissey, hard for joining the legal action to have Obamacare overturned. His television campaign adverts repeatedly remind West Virginians who rely on government health protections in some form about the threat to the guarantee of insurance for people with pre-existing conditions. Manchin has tied that to Morrissey’s years as a lobbyist for the pharmaceutical industry and his wife’s work for a major drug distributor, in the state worst hit by the opioid epidemic.

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The GOP acknowledges Manchin’s attacks over healthcare have had an effect, helping put the senator ahead in a race Republicans thought they would win. Morrisey’s attempts to paint Manchin’s support for immigration reform as putting down a “welcome invitation for caravans and illegal immigrants to enter the country” do not appear to have grained traction.

In Arizona, congresswoman Martha McSally admitted she is getting her “ass kicked” in her race for the US Senate over her votes for scrapping Obamacare despite a concerted effort to play on immigration fears.

Facebook Twitter Pinterest Martha McSally, left, who is running against Krysten Sinema, said she is getting her ‘ass kicked’ over her votes to scrap Obamacare. Photograph: Matt York/AP

McSally, who was the country’s first female combat pilot, has moved to the right on immigration over recent months. But it has not played well with independents, who make up about one-third of the electorate and put healthcare and education as their primary concerns.

Her Democratic opponent, Kyrsten Sinema, is favoured to take the seat after running a campaign that relentlessly focused on what she said was the threat McSally poses to healthcare for people with pre-existing conditions.

“I did vote to repeal and replace Obamacare on that House bill. I’m getting my ass kicked for it right now because it’s being misconstrued by the Democrats,” McSally told Sean Hannity on his radio show. “They’re trying to invoke fear in people who have family members or loved ones with pre-existing conditions.”