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WASHINGTON — The Texas Democrats competing for the party’s nomination for U.S. Senate are talking about health care more than anything else, and it is one of the few issues that offers a sharp dividing line between the dozen candidates in the race.

Amanda Edwards’ father died of cancer when she was 17. Her mother has cancer now. She gave up a safe path to a second term on Houston’s City Council with health care at the top of her mind. She wants to expand the Affordable Care Act to include a government-backed insurance plan.

Cristina Tzintzún Ramirez, a longtime labor organizer, says she learned from the negotiating table to always start big: She’s pushing for Medicare For All, essentially doing away with private health insurance. So is Sema Hernandez, who says she learned working as an insurance agent how “dirty” insurance companies are.

MJ Hegar, a decorated former Air Force pilot, says she knows how good government health care can be. So does Chris Bell, who was on a low-cost government insurance plan as a congressman when his wife was diagnosed with cancer. Both think everyone should be able to access Medicare if they want, but consumers should still have choices in the marketplace.

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Longtime state Sen. Royce West, meanwhile, has for years joined Democrats in urging Republican leaders to expand Medicaid as Texas remains the nation’s leader in uninsured residents.

Democrats across the nation see health care as their best issue, and it’s no different in Texas for those challenging three-term incumbent Republican Sen. John Cornyn, a key player in the GOP's attempts to dismantle the Affordable Care Act.

Cornyn has had more than two years to prepare for the inevitable attacks, and has already labeled all of their proposals as socialist takeovers of the health insurance market, as championed by Democratic presidential contenders Sen. Bernie Sanders and Sen. Elizabeth Warren.

“Even we were surprised at how quickly all of our major opponents have, in some form, adopted the Warren/Sanders approach of forcing everyone out of their employee insurance into a government run plan,” said Krista Piferrer, a spokeswoman for Cornyn. She said Cornyn “has long supported legislation that helps the uninsured and protects those with preexisting conditions, but also sees Obamacare for the cost-prohibitive, job-killing program that it is.”

The Democrats are going all in.

“It is the No. 1 issue,” said U.S. Rep. Cheri Bustos, an Illinois Democrat who chairs House Democrats' campaign arm. “I can tell you this firsthand coming from a district that Donald Trump won, I can tell you from polling in some of the toughest districts in the country, it is the No. 1 issue that people want us to address, the cost of health care.”

House Democrats last year passed legislation that would allow the government to negotiate lower prices for drugs in Medicare, which has gone nowhere in the Senate. They’re already running ads about how the GOP stalled it.

Trump renews call for drug price controls

Democrats won’t be alone in making big promises on health care through November. In his State of the Union address, President Donald Trump urged Congress to act on drug prices, saying “Get a bill to my desk, and I will sign it into law without delay.”

Trump’s comment — made even as the White House threatens to veto the bill that passed the House — drew shouts from Democrats in Congress who attended the speech. The president also vowed to “always protect patients with pre-existing conditions,” despite his administration’s support for the Texas legal challenge seeking to strike down Obamacare’s most popular provision.

Cornyn and the Republicans say they have a replacement to protect those with pre-existing conditions.

“Texans shouldn’t have to fear being denied access to affordable health insurance because of a pre-existing condition,” said Cornyn last spring as the Protect Act that he cosponsored was introduced. “This legislation will give them peace of mind they can choose an insurance plan for their families that offers quality, patient-centered coverage.”

An analysis of the bill by the New York Times, however, found that the language in it does not clearly protect those with pre-existing conditions from higher premiums, and that patients with cancer, diabetes and HIV, for example, would have significantly less protection than they have under the Affordable Care Act.

Democrats in the senate primary argue the issue matters more in Texas than anywhere else. The state has the highest uninsured rate in the nation, and over 900,000 Texans received subsidies last year through the ACA’s federal marketplace.

The state is one of a handful that hasn’t expanded Medicaid to cover more low-income adults using federal money made available by the ACA and state efforts to expand Medicaid coverage for new mothers and children have failed.

‘Profit off our pain, suffering and illness’

Texans in a recent Texas Lyceum poll listed health care as the top issue facing the nation. And polling suggests a big appetite among Texas residents for universal healthcare — something many in the Democratic Senate primary are promising to push.

“By having a health care system where private health companies profit off our pain, suffering and illness, we’ve created the most expensive health care system in the world,” Tzintzún Ramirez said. “I’m glad we’re having the debate we’re having inside the Democratic party, but what we also need to understand is private insurance companies, pharmaceutical companies are going to continue to spend hundreds of millions to continue the broken system we have.”

She argues universal health care would be a boon for small businesses and entrepreneurs who wouldn’t have to foot the bill for health care for their employees. And she says unions — many of which have members who are happy with their current coverage — would be freed up from negotiating for better health coverage and could make gains on pensions and other benefits.

Annie “Mama” Garcia, who runs a Houston-based health care-focused nonprofit, wants to build a universal healthcare system in America like the one in Spain, where her daughter was treated for a heart defect as an infant. Though Garcia lives five minutes from the Texas Medical Center, she says she still flies back to Spain annually for her daughter’s checkup. Mostly, Garcia said the trip is to see the same team that saved her daughter’s life, who she knows she can trust. But Garcia says she also knows there won’t be any surprises. She knows how much the flight costs, how much an Airbnb will be. The doctor’s visit will be free.

“Financially it’s a better bet,” she said.

Most in the race wouldn’t go that far.

‘They need it now’

While Hegar says she was believes she had the best health care when she was in the military, she wouldn’t force it on anyone.

“We are a nation and a state that values individual rights and freedoms,” Hegar said. “A lot of people are happy with their plans. I would argue they don’t know how good it is on Medicare, but I can tell you this — if private insurance is going to survive when people have access to Medicare … they’re going to have to get better to be able to compete.”

Bell has a similar belief.

“On these issues it’s always a little easier to figure out your position when you’ve had personal experience,” he said. His wife was diagnosed with breast cancer during his last year in Congress. She did six months of chemotherapy treatments every two weeks. Each one cost $6,000, Bell said. She also had surgery, but he didn’t remember the cost.

“You can just do the math on that and realize making the congressional salary at the time with over $200,000 in medical bills, that would have been - well, impossible,” Bell said.

Had he not had congressional insurance, he says, “we probably would’ve been one of those families looking at bankruptcy.”

Edwards said she learned quickly how important health coverage is when her father was diagnosed with cancer when she was 10. He was able to get good care and his life expectancy doubled.

“It’s something that touches me very directly,” she said. “Even though my dad had a terminal illness ... The difference of my dad dying when I was 17 versus my dad dying when I was 14 was light years away in terms of the lessons I learned.”

She argued there isn’t time to start anew with Medicare For All.

“People who need health care, they need it now,” said Edwards, who supports bolstering the ACA and gets her health care through the federal marketplace it established. “They don’t need to wait and watch Washington debate it.”

West also supports building on what’s already in place.

In Texas, prices for coverage under the ACA this year range from $201.26 per month to $1,251.45 per month, depending on age. In the second lowest cost silver plans, considered the benchmark from which subsidies are calculated, the cheapest runs $319.39 for a 27-year-old; $389.49 for a 40-year-old; and $827.13 for a 60-year-old.

“We don’t need to throw the baby out with the bathwater,” West said. “I’ve never seen a perfect piece of legislation … An ultimate objective should be to have a health care system everyone can share in.”

ben.wermund@chron.com