Heitkamp Localizing Health Care Politics

By Julie Sobel  //  August 9, 2012 | 11:59 a.m.

Heidi Heitkamp has taken a novel approach to dealing with a tricky issue in the North Dakota Senate race: President Obama's health care law. Back in June, the Democrat was the first candidate to run a television ad directly addressing the controversy, defending parts of the law and saying there were also bad elements in the bill. And lately, she has taken another unique approach to defending the bill: Singling out one piece of the law that is applicable to North Dakota and arguing that it won't pass again if there's full repeal.

Heitkamp's June ad was her first major foray into health care, and came at a time when outside groups were attacking the former Attorney General over her past praise for the president's health care law. "I would never vote to take away a senior's health care or limit anyone's care," says Heitkamp in the ad. "There's good and bad in the health care law that needs to be fixed. But Rick Berg voted to go back, to letting insurance companies deny coverage to kids or for pre-existing conditions."

Lately, Heitkamp has added a new, North Dakota-centric aspect to her message on the health care bill.

"There's a lot of fixes that need to be made to health care reform, but the reason I would not vote to repeal health care reform is I would not want to lose the Frontier Amendment," Heitkamp said on the campaign trail in mid-July, according to the Minot Daily News.

Then, in a meeting with the Fargo Forum editorial board, Heitkamp told them that "the single reason why I would not vote to repeal the Affordable Care Act is the Frontier Amendment."

The Frontier Amendment, part of the health care bill, sends millions in federal Medicare funding to North Dakota hospitals to offset the state's low Medicare reimbursement rate. The North Dakota delegation supports the Frontier Amendment, including Berg. "We need to be extraordinarily careful because I know Congressman Berg has talked on and on and on about repealing and replacing, and what I'm saying is there are provisions in the Affordable Care Act that are unique to North Dakota that will never be passed again," Heitkamp said in a speech Wednesday night. "I will challenge anyone who tells me that you can repeal the Affordable Care Act and get the Frontier Amendment passed as a standalone -- it won't happen." As I noted when Heitkamp launched her June ad, it's not ideal for Heitkamp to have to spend a lot of time talking about the health care law -- in a Republican state where votes view it unfavorably. But it makes sense to try to zero in on a locally popular piece of the law and use it to try to put Berg on the defensive. And the emphasis on one aspect of the law that's popular on the state level also fits with Heitkamp's strategy of keeping a focus on North Dakota issues in a GOP-leaning state where Obama will lose to Mitt Romney in November. If all politics isn't local, to borrow Tip O'Neill's maxim, she's hoping that national politics can be localized to her favor.

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