with Paulina Firozi
Today we’ll find out whether their tune was prophetic.
Democrats could seize the House majority for the first time in eight years as Americans head to the polls for the midterm elections. If Democrats manage to flip that chamber, it will be on the heels of a campaign season in which they unrelentingly — and seemingly effectively — blasted Republicans for spending much of 2017 trying to ditch the Affordable Care Act and its patient protections.
You could put it this way: After years of winning elections by promising to get rid of Obamacare, Republicans might now lose because they followed through on that promise (though their bid ultimately failed in the Senate.)
“Look, opposition is a lot easier,” Brad Woodhouse, a veteran Democratic political operative who now heads the group Protect Our Care, told me. “When Republicans started coming after benefits that people enjoy, it was pretty easy to point the finger.”
Woodhouse said the Democratic strategy to prioritize health care -- especially protections for preexisting conditions -- was the subject of “considerable debate” among Democrats and activists in the aftermath of the 2016 elections. In those conversations, a consensus emerged that candidates would stay away from attacking Trump and his personality and instead keep the focus on GOP-led policies.
“We’ve made it about their sabotage, their repeal agenda,” Woodhouse said. “We’ve kept the focus on them.”
This was precisely the strategy advanced by the Hub Project, a Democratic organization led by Leslie Dach, who also serves as campaign chair of Protect Our Care. The Hub Project is spending nearly $30 million of so-called "dark money" on trying to flip vulnerable Republican seats with focused attacks on their votes around health-care and taxes, per a report by the New York Times's Alexander Burns.
"The quiet onslaught embodied two of the most important strategic choices by Democrats in the 2018 elections — putting health care and taxes at the core of their message, and using invigorated fund-raising on the left to challenge Republicans even in conservative-leaning areas," Alexander writes.
Democrats previously had trouble selling other parts of the ACA to the public. But protections for people with preexisting conditions were always the most popular part of the bill, which polling confirms.
Patients have also had access to Obamacare for four years now -- making the law's benefits harder to take away as more and more insurance plans are complying with the ACA. And even though Republican lawmakers ran for years on a repeal-and-replace agenda, it seems the actual act of voting to repeal the law opened them up to a political fight they may not have been able to win.
Republicans seemed to recognize the danger, running plenty of ads seeking to assure voters they would fight to retain preexisting conditions, even if they opposed keeping Obamacare. And Democrats sometimes went too far in exaggerating what their repeal effort would have done to undermine protections for patients.
But the message became crystal clear to voters, anyway.
“If you have a credible threat against preexisting condition protections, then you have a very winnable fight,” said Chris Jennings, who served as a health policy adviser to both Obama and Bill Clinton.
Jennings and Woodhouse told me that as Democrats looked at the polling data and ran focus groups, the party organizations, congressional leaders and outside activists came to an agreement that preexisting conditions should be their chief message in the midterm elections.
“It really started to unify Democrats and it was pollsters, strategists, Obama people behind the scenes and others,” Jennings said. “Democratic leadership was very, very much involved in the organization of this, as well as Protect Our Care … it was a very tight group of people.”
House Minority Leader Nancy Pelosi (D-Calif.), in a letter yesterday, urged House Democrats to keep focusing on health care in their final hours of campaigning.
“I urge all of us to continue to push this message in the next 24 hours,” Pelosi wrote. “Health care is the key factor in voters’ decisions.”
The potency of the Democratic message is demonstrated by the political danger in which Republicans who were involved in the negotiations to pass the House GOP bill find themselves. Some of them are in serious danger of losing their seats.
It's made worse by the fact that a similar measure to the House bill -- known as the American Health Care Act (AHCA ) -- failed in the Senate, meaning Republicans are on record voting against something they didn't manage to defeat.
Rep. Tom MacArthur (R-N.J.), who put himself on the line to get the House GOP bill approved, is fighting for his political life. So is Rep. Fred Upton (R-Mich.), who also became a key figure when he announced his opposition to the AHCA, citing concerns it would erode preexisting condition protections. Upton ultimately came back on board after persuading the GOP leadership to tack on an additional $8 billion to help cover people hurt in states that got waivers.
And it’s not just moderate Republicans in tough races. Reps. Dave Brat (R-Va.) and Scott Perry (R-Pa.), members of the House Freedom Caucus, are also endangered. They and other hard-line conservatives were a lot more worried about lifting Obamacare requirements than about retaining its consumer protections.
Perhaps reflecting how nervous Republicans feel about today’s elections, Trump and his staff have been even more insistent in recent weeks that they’re not doing anything to hurt people with preexisting conditions — even though the Justice Department is refusing to defend the ACA against a state-led lawsuit.
White House Press Secretary Sarah Huckabee Sanders:
.@PressSec: “The president’s been clear. Whatever policy he puts forth on health care, it will protect pre-existing conditions.” @foxandfriends pic.twitter.com/ebNNZuUO2w
— Fox News (@FoxNews) November 5, 2018
In the end, Congressional Republicans served themselves up a double whammy on health care. They didn’t manage to repeal Obamacare because the Senate fell one vote short. And, their votes for the AHCA opened the door to an aggressive offensive by Democrats. More than 50 percent of Democratic campaign ads from mid-September to mid-October mentioned health care, and the GOP bid to take away preexisting conditions was the chief refrain among those, as my colleague Paul Kane notes.
Indeed, the GOP's effort to repeal and replace Obamacare turned health-care politics upside down to an extraordinary degree. After years of being forced to defend Obamacare’s shortcomings, Democrats have managed to shift the focus from its unpopular parts (such as its mandate to buy coverage) to its most popular provision, its the preexisting conditions protections.
“Republican House and Senate members (bless their hearts) couldn’t figure out how to repeal and replace the ACA convincingly or successfully, but they did manage to achieve the near-impossible: Make the law popular!,” wrote Tom Miller, a health-care expert at the conservative American Enterprise Institute.
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AHH, OOF and OUCH
AHH: For the first time in nearly three decades, donors who identify themselves as “retired” contributed more to Democratic candidates than Republicans in the midterm elections, according to data from the nonpartisan Center for Responsive Politics.
Out of the $326 million these donors contributed to various candidates through Oct. 17, 52 percent went to Democrats versus 48 percent to Republicans, the Wall Street Journal’s Julie Bykowicz reports.
“This is the first midterms since the group began keeping donor industry data in 1990 in which retirees favor Democrats over Republicans,” Bykowicz writes. “That year, retirees gave 76% of their $15 million in contributions to Republicans and 24% to Democrats.”
“As Social Security and Medicare have become hot-button political issues, retiree donors have steadily crept toward Democrats, the center’s data show. By 2002, the GOP advantage among retiree donors had declined to 63% versus 36%. Eight years later, the split was 55%-44%.”
OOF: The Centers for Disease Control and Prevention is warning of the possibility that the Ebola outbreak in the Democratic Republic of Congo is not containable.
Ebola could instead become entrenched in the region, our Post colleague Lena H. Sun reports. “If that happens, it would be the first time since the deadly viral disease was first identified in 1976 that an Ebola outbreak leads to persistent presence of disease,” she writes. “In all previous outbreaks, most of which took place in remote areas, the disease was contained before it spread widely. The current outbreak is entering its fourth month, with nearly 300 cases, including 186 deaths.”
The consequence would mean the deadly virus would spread unpredictably. CDC Director Robert Redfield and other health experts say one of the major concerns is if Ebola spreads to major trade regions where “the risk of widespread transmission escalates dramatically.”
“The outbreak is taking place in a part of Congo that is an active war zone," Lena writes. "Dozens of armed militias operate in the area, attacking government outposts and civilians, complicating the work of Ebola response teams and putting their security at risk. Violence has escalated in recent weeks, severely hampering the response. The daily rate of new Ebola cases more than doubled in early October. ”
“In addition, there is community resistance and deep mistrust of the government. Some sick people have refused to go to treatment centers, health-care workers are still being infected, and some people are dying of Ebola or spreading the virus to new areas.”
OUCH: Doctors are struggling to explain the third nationwide peak since 2014 of the rare polio-like condition, acute flaccid myelitis.
The Centers for Disease Control and Prevention is investigating 219 reports of patients with the disease so far this year, with 80 of those cases confirmed to be AFM. That’s up from 33 confirmed cases last year, the Wall Street Journal’s Sumathi Reddy reports. The spikes in cases have come every two years since 2014 and have almost always been in children.
The CDC confirmed 149 cases in 2016 and 120 cases in 2014.
“Doctors and the CDC differ on the possible cause of the condition and how to treat it,” Sumathi writes. “Many doctors speculate AFM is largely fueled by a common virus called the enterovirus, which for most people causes nothing more than a routine upper-respiratory infection. But the CDC believes there could be other culprits. Some experts believe the condition likely existed before 2014 and think there could be more cases, since there is no national requirement to report as there is for many other conditions, including influenza and measles.”
“If there was mandatory reporting, it would help with surveillance,” Keith Van Haren, an assistant professor of neurology at the Stanford University School of Medicine, told Sumathi. “This doesn’t appear to be going away. We need to be preparing and anticipating the possibility of a more severe outbreak.”
STATE SCAN
— Our Post colleague Christopher Ingraham has another helpful look at all the marijuana initiatives on the ballot today and where they are most likely to win.
He writes that the latest polls show Michigan’s measure on recreational marijuana use passing with a comfortable margin.
As for Nebraska’s measure on legalizing recreational pot, he writes the polling is “all over the place, with two surveys fielded at roughly the same time in October yielding opposite, lopsided results: One showed the initiative passing 51 percent to 36 percent, while the other showed it failing with 65 percent opposed. With numbers like those, it’s hard to predict how this one will shake out.”
In Missouri, where there are three separate medical marijuana initiatives, polling has been “scant,” Christopher writes, “but a survey in August showed that voters supported, in general terms, an amendment to the state constitution that would legalize medical marijuana. If two or more of the measures pass, it’s likely that the measure that receives the most votes will go into effect.”
And in Utah, he reports the “eventual result is essentially a foregone conclusion” because of the compromise struck between both sides on the measure in the state.
Read more on these measures on the ballot from The Health 202 here.
— A judge in Maine is scheduled on Wednesday to hear oral arguments in the legal case over the fate of Medicaid expansion in the state, where the program has yet to be implemented after voters overwhelmingly approved a ballot initiative last year.
“The judge will decide whether Republican Gov. Paul LePage’s administration has broken the law by stalling expansion,” the Associated Press reports. “A pro-Medicaid-expansion group, Maine Equal Justice Partners, says LePage’s administration is violating the spirit of a court order to submit paperwork for federal funding. Maine submitted the paperwork, but LePage urged federal regulators to reject it.”
The hearing will also come the day after the midterms in which multiple gubernatorial races and four ballot initiatives have the potential to expand the current list of states that have expanded Medicaid under the ACA. Janet Mills, the state's Democratic attorney general who is running to replace the term-limited LePage, has recused herself from the lawsuit. “But her office filed a legal brief supporting Maine Equal Justice Partners’ lawsuit that says Maine has enough state dollars to pay for Maine’s expansion,” per the AP.
— A ballot initiative in Ohio that would reduce drug penalties has been motivating turnout in Cleveland, Jordan Heller reports for The Post, and it has specifically motivated African American voters who also say they’re going to the polls to vote against Republicans. Cuyahoga County Board of Elections officials say turnout for this midterm election is “historic.”
“Ohio Issue 1 has largely been promoted as a response to the opioid crisis, and many commercials urging people to vote yes on Issue 1 feature white people talking about opioid abuse,” Jordan writes. “Under the ballot initiative, possession of drugs would be a misdemeanor instead of felony. Penalties for drug trafficking would not change.”
“Lots of black people went to jail for crack in the 1980s, and a lot of them are still there. Right now, the minority community is saying, ‘No more, no more,'” Kim Thomas, minority engagement consultant for the Cuyahoga County Democratic Party, told Jordan. “We want the same opportunity for treatment instead of jail time, and if Issue 1 is gonna speak to that, then we’re gonna support it.”
MEDICAL MISSIVES
— Gun control is one issue that seemingly fell off the map of voter priority in the months leading up to the midterm elections, our Post colleague Andrew Van Dam reports. He mapped out Google searches for political issues across the country and found that in February, the month 17 people were killed in a shooting at Marjory Stoneman Douglas High in Parkland, Fla., most the country was searching for terms related to gun control, but such search interest dropped off by October.
— And here are a few more good reads from The Post and beyond:
INDUSTRY RX
AGENCY ALERT
HEALTH ON THE HILL
DAYBOOK
Coming Up
- Brookings Institution holds an event on girls’ education research and policy on Wednesday.
- Brookings Institution holds an event on the results and implications of the midterm elections on Thursday.
- American Enterprise Institute holds an event on postelection analysis on Thursday.
- The Food and Drug Administration holds its “Vaccines and Related Biological Products Advisory Committee Meeting” on Thursday.
- The American Medical Association holds its research symposium on Friday.
SUGAR RUSH
Two years after Donald Trump’s 2016 upset victory, political reporters and pundits aren't as likely to make firm predictions about the 2018 elections:
Trump’s closing remarks before the midterm elections, in 3 minutes
What happens if Democrats win the House?