The political ramifications of the House vote to repeal and partially replace Obamacare won’t be fully known until the mid-term elections in 2018, but the Democratic and Republican congressional campaign committees and their supporters went to work immediately after the bill passed on May 4.
The American Health Care Act ( H.R. 1628) is expected to be a central issue in the campaign by Democrats to take back control of the House. Their strategy was telegraphed by House Minority Leader Nancy Pelosi (D-Calif) when she said the vote would be “tattooed” to Republican candidates and will “glow in the dark.”
What’s unclear is how this would mesh with other issues, such as Democrats’ potential use in the campaign of the president’s May 9 dismissal of FBI Director James Comey.
The political impact of the House health-care bill is far from clear, according to Michael L. Young, a speaker and political analyst and former professor of politics and public affairs at Penn State University. The election is still 16 months away, and Republicans in swing districts can control their own fate to some extent by voting against the bill and proactively engaging with their constituents, Young told Bloomberg BNA in an email.
After the health-care vote, the Democratic Congressional Campaign Committee (DCCC) immediately launched an ad campaign in 30 districts held by Republicans (see graphic). The National Republican Congressional Committee (NRCC), defending the vote, launched a web ad campaign May 5 called “Promise Made, Promise Kept.”
Democrats say the backlash has already begun, as members of Congress returned to their districts for a recess.
“There’s not a single Republican who is getting a free pass on House passage of this heartless legislation,” DCCC spokesman Tyler Law said in a statement.
The Democrats need to pick up 24 seats to take control of the House. They have targeted 30 districts in 18 states with their ad campaign. There are 23 seats held by a Republican where Hillary Clinton won in 2016 and another 10 where she lost by four points or less, according to the DCCC.
Democrats are banking on the support of the so-called “resistance” to President Donald Trump, the apparent popularity of the Affordable Care Act and the apparent unpopularity of the American Health Care Act.
A poll by the Pew Research Center in February found that 54 percent of those polled approved of the ACA, or Obamacare, while 43 percent disapproved.
Lee M. Miringoff, director of the Marist Institute for Public Opinion, told Bloomberg BNA it’s too early to predict how the House vote will impact the 2018 mid-term elections. He said action in the U.S. Senate, potential reconciliation between the House and Senate versions and other factors could have an impact on voters.
“Things are going at such a warp speed right now,” he said. “There has to be a little caution in jumping to those conclusions.”
Miringoff said, however, that “there is one clear indication and that is the energy that the Democratic constituencies are showing.”
“It’s sort of like what the Tea Party had going for them in 2010,” he said. “That’s something that isn’t going away anytime soon.”
Marist’s last poll on health care was in late February. It found that 67 percent of respondents didn’t think Congress should completely repeal the Affordable Care Act.
Twenty-one percent of respondents said Congress should let the ACA stand in its current form, 39 percent said it should be changed so that it can do more and seven percent said the law should be changed so that it does less.
A Quinnipiac University poll released at the end of March found that only 17 percent of respondents approved of the American Health Care Act, which was amended subsequent to the poll. Fifty-six percent disapproved of the bill and 26 percent were undecided.
The poll found that 46 percent of respondents would be less likely to vote for their members of Congress if they voted in favor of the AHCA, while 19 percent said they would be more likely to vote for them.
“With such strong public opposition to the Republican health care plan, Republicans who are in districts won by Hillary Clinton will be especially vulnerable,” Tim Malloy, assistant director of the Quinnipiac University Poll, told Bloomberg BNA in an email.
“Health care is one of those from-the-gut issues that affects every household,” he said. “It’s deeply personal.”
The liberal group Swing Left has identified 65 “swing” districts, which include districts: where Republicans won the last election by 15 percent of the vote or less; where Hillary Clinton beat Donald Trump; or that had a high concentration of Swing Left volunteers.
“If we hold the 17 vulnerable Democratic-held districts, we only need to flip 24 House seats—exactly half of the 48 Republican-held districts on our list—to take back the house in 2018,” the group said on its website. “This is a winnable fight.”
Republicans plan to hold Democrats responsible for protecting “the status quo” and for failing to provide relief from “the crushing weight of Obamacare,” according to a May 4 memo from the NRCC.
“Over the next year on the campaign trail, Democrats must answer why they stand in opposition to providing any relief at all from this unmitigated disaster of a law,” the memo said.
“No matter where they voted today, the NRCC supports our members and will be behind them 100 percent in 2018, as we continue to expand our Republican majority,” it said, referring in part to the 20 Republicans who voted against the bill.
Republicans who are considered vulnerable will also be buoyed by the conservative-leaning American Action Network (AAN), the group which spent $10 million to lobby in support of the American Health Care Act.
AAN is now spending an additional $2.5 million on an ad campaign in 25 districts held by Republicans, including 17 targeted by the Democrats. The ads thank the members personally for their votes and highlight the benefits of the AHCA.
“Conservatives kept their promise of replacing the Affordable Care Act with much-needed patient-centered reforms that empower individuals, not Washington bureaucrats,” Corry Bliss, AAN executive director, said in a statement. “While liberals defend the status quo and resort to cheap political stunts, AAN will continue to share the benefits of the American Health Care Act.”
One of the Republicans identified as vulnerable by Democrats is freshman Rep. John J. Faso (R-N.Y.), who represents a district near Albany. Faso has been targeted by the DCCC, Swing Left and two anti-Trump “Indivisible” groups, which hold regular “Faso Friday” protests in his district.
Faso defeated his Democratic opponent, Zephyr Teachout, by 26,000 votes in 2016, or 8.6 percentage points, according to Swing Left, which has targeted Faso for defeat.
Courtney Weaver, a spokeswoman for Faso, said he campaigned successfully on repeal and replace in 2016.
“He was sent to Washington to fix the failures of Obamacare,” Weaver told Bloomberg BNA in an email. “Right now, the Congressman is focused on his job to fix the problems Washington has created.”
Faso, a former Republican candidate for governor of New York, said the Affordable Care Act “will collapse under its own weight if nothing is done.”
“From the start of this process, I have stated that the responsible path forward includes keeping what works and fixing what doesn’t,” he said in a statement.
An issue that’s expected to be raised in the 2018 contest for Faso’s seat is the so-called Collins-Faso amendment. Faso and Rep. Chris Collins (R-N.Y.), have generated considerable opposition from Gov. Andrew M. Cuomo (D) and others for an amendment to the AHCA which would prohibit the state from requiring that upstate counties share the cost of the Medicaid program.
Cuomo says the Collins-Faso amendment will cost the state an additional $2.3 billion a year. Faso said over 40 percent of the tax burden in his district can be attributed to the share of Medicaid paid by counties.
Collins, whose Buffalo-area district is not one of the three in New York on the DCCC target list, said he “fulfilled a promise I made to western New Yorkers to repeal and replace Obamacare.” Collins said his amendment could save taxpayers in his district $470 million in property taxes.
“Democrats in Washington and Albany are hell-bent on spreading misinformation about the AHCA to distract from the daily failures of Obamacare,” he said in a statement emailed to Bloomberg BNA. “Despite these attacks, I am proud to stand with President Trump to protect and strengthen health care for families across America.”
All 14 California House Republicans voted for the health-care bill, and at least five of them are targets for Democrats in the 2018 race. Perhaps the most vulnerable is Rep. Darrell Issa (R-Calif.), who said he was undecided as the vote approached and cast one of the last votes to reach the 217 threshold needed to pass the House.
Issa has held the 49th Congressional district since 2001, but his victory margins have been declining. He won the coastal Orange County district with 50.3 percent of the vote in November 2016, nearly losing to Democratic challenger Douglas Applegate, who won 49.7 percent of the vote. In 2014, Issa won reelection with 60.2 percent of the vote, compared to 39.8 percent for his Democratic challenger, Dave Peiser.
Issa’s district leans Republican with 37.9 of registered voters and 31.1 percent Democratic. Republican registration growth is slowest in his district compared to Democrats and those registering in other categories, Paul Mitchell, vice president of the nonpartisan California data firm Political Data, told Bloomberg BNA.
In a prepared statement after the vote May 4, Issa said he was keeping a promise to repeal and replace the ACA. “Obamacare is doing real harm to California’s families and struggling businesses, and constituents are counting on me to deliver real relief,” he said. “Obamacare was a failure from the get-go. Now is the time to make it right.”
Rep. Jeff Denham (R-Calif.) faces a growing Democratic majority among registered voters in his Central Valley district, which covers parts of Stanislaus and San Joaquin counties. Democrats make up 39 percent of registered voters in Denham’s district, compared to 36.4 percent registered Republicans.
A former state legislator, Denham first won the seat in 2010. In November 2016, he won 51.7 percent of votes over his Democratic challenger, Michael Eggman, who had 48.3 percent. This was a decline from 2014, when Denham won with 56.1 percent of the vote compared to Eggman’s 43.9 percent.
In the district, which includes the city of Modesto, Democrats are gaining new registered voters fastest, followed by other registrations and Republicans, Mitchell said.Denham was undecided as the vote approached, but said after the vote that the AHCA would improve access to health care.
“While coverage in the Valley has expanded—and that’s a good thing—the access issues that existed before the ACA have only gotten worse with the expanded coverage,” Denham said in a statement. “California ranks 48th in the U.S. for Medicaid reimbursement rates, creating a disincentive for physicians to accept more patients covered through Medi-Cal.”
Mitchell said Issa and Denham represent districts that are so dissimilar they are more like two different states. These differences make them vulnerable for different reasons, he said.
Even though voter registration in Issa’s district leans Republican, those voters are more likely to be highly educated, liberal, and independent and therefore less energized for a mid-term election. At the same time, Democrats in his district are loyal to the party.
“He needs every Republican vote he can get,” Mitchell said.
In contrast, Denham is more able to overcome the Democrats’ voter registration advantage because Democrats in his district tend to be more conservative and less partisan.
Although Denham looks more vulnerable on paper, Issa is more vulnerable, Mitchell said.
Activists and ACA supporters—already working to defeat Issa, Denham, and several other vulnerable Republicans—launched a new series of events called Recess of Rage in response to the May 4 vote. The American Cancer Society, American Lung Association, Planned Parenthood Affiliates of California, Health Access, and others held protests and vigils at Issa’s and Denham’s offices, and showed up at a mixer and a coffee Denham hosted for constituents.
California is arguably the most successful in its embrace of the ACA, with 5 million people newly insured through the health benefits exchange or the Medicaid (Medi-Cal) expansion, Anthony Wright, executive director of consumer advocacy group Health Access California, told Bloomberg BNA. California has 11 insurers in its exchange, in contrast to other states with one or two.
In Denham’s district, one-third of the 300,000 people who have care under the ACA or Medicaid could lose coverage. Those who remain could see their benefits cut because of the Medicaid cap or other changes. Issa has fewer beneficiaries of the ACA in his district, but almost 65,000 of his constituents are receiving help through ACA, according to data compiled by Health Access.
“The national talking points don’t work,” Wright said. “They’re getting national talking points from leaders in Washington and they make no sense.”
One out of five House Republicans who voted against the health-care bill come from Pennsylvania, with three of Pennsylvania’s four “no” votes coming from southeastern districts that Democrats hope to regain in 2018.
Republican Reps. Ryan Costello, Pat Meehan and Brian Fitzpatrick all reside in suburban swing districts just outside of Philadelphia that have been targeted by the DCCC.
All three are members of the Tuesday Group, an informal caucus of about 50 moderate House Republicans that are behind more than half of the bill’s “no” votes. The fourth “no” vote came from Rep. Charlie Dent (R-Pa.), a moderate who co-chairs the Tuesday Group and has been one of the most vocal Republican opponents of the health care bill.
Although Dent voted against the bill, he is not considered vulnerable, as he won his seventh term last fall with a 20-point margin.
Meehan and Costello both come from districts that Hillary Clinton won in the general election, by 2.3 points in Meehan’s district and less than a point in Costello’s. Fitzpatrick is from a district that Trump won, but just barely, by 0.2 percentage points.
“They’re more purple districts than they are ruby red,” Brandon Cwalina, press secretary for the Pennsylvania Democratic Party, told Bloomberg BNA.
Democrats also have their eye on the 16th district, a traditionally conservative district that has not elected a Democratic representative since 1945. The district elected Rep. Lloyd Smucker (R-Pa.) in 2016 with an 11 percentage point margin and favored Trump to Clinton by 51 to 44 percent.
The district could be in play because increasing numbers of new voters are moving into the area and that could make the district “more purple,” Cwalina said.
Smucker voted in favor of the health care bill, saying that Affordable Care Act premiums in Lancaster County increased by 40 percent in 2017, the highest in Pennsylvania.
The response to Smucker’s vote has been mixed, according to the congressman’s spokesman, Bill Jaffee. He said Smucker has “met with countless constituents, health care professionals, doctors, and organizations specifically about health care.”
“As expected, there are lots of opinions on both sides of the aisle,” Jaffee told Bloomberg BNA in an email. “Rep. Smucker is focused on lowering health care costs for his constituents. The current system is broken and on the verge of collapse.”
Young, formerly with Penn State, noted that the final result from the Senate will be as important as what happened in the House. “At this point it looks like any resemblance to the House bill will be a casual one, mooting politically what happened in the House,” Young said. “Even House yes votes like Smucker could survive if the Senate produces a bill that lowers premiums while solving some of the other problems of the AHCA.”
To contact the reporter on this story: Gerald B. Silverman in Albany, N.Y., at GSilverman@bna.com; Laura Mahoney in Sacramento, Calif., at email@example.com; and Leslie A. Pappas in Philadelphia at firstname.lastname@example.org
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