WILLINGBORO, N.J.—Andy Kim, a soft-spoken former foreign policy adviser in the Obama administration, stepped to the microphone before a packed crowd at a community center an hour outside Philadelphia. He stood alongside an empty chair, ostensibly reserved for GOP Rep. Tom MacArthur, and spent the next two hours talking to South Jersey voters about their health care concerns. Many expressed worry about rising premiums and the prospect of losing coverage. One woman, whose son has a rare neurodegenerative illness, sobbed as she recounted how she was forced to file for bankruptcy because of the exorbitant costs for treatment that he requires.
Kim, whose expertise is on national security, not health care, pledged to protect the Affordable Care Act and fight the Trump administration’s attempts to cut benefits. He spoke in gauzy generalities, declining to endorse any specific proposal, like a single-payer health system championed by progressives. But he regularly slammed MacArthur for his efforts to repeal Obamacare, convinced that the GOP’s efforts to repeal the law will be a Democratic lifeline in a district that Donald Trump carried. Indeed, MacArthur’s legislative amendment allowing states to opt out of several of the health care law’s main provisions was a rallying cry for many of the (predominantly liberal) attendees.
“Health care is the No. 1 issue people are talking about in this district. It’s incredibly important. People are scared about this,” Kim said in an interview before the event. “I’d bet everyone in that room either has a preexisting condition or knows someone who does. This isn’t just about policy on a piece of paper; it affects people’s lives.”
If the issue of health care has turned from an albatross to an advantage for Democrats, one need look no further than this district as a key indicator of that shift. MacArthur, a former insurance executive, took a lead role in negotiating a rollback of Obamacare—even though he represents a swing district that voted for both Barack Obama (twice) and Trump. His amendment would have relaxed the requirement for insurers to require coverage for those with preexisting conditions. “We probably can’t talk about repeal-and-replace anymore,” MacArthur conceded last month in an interview with The Washington Post.
It’s a remarkable shift for Republicans, who have been running against Obamacare as a key campaign plank in the last four elections. Without Democrats in power and after a failed attempt to repeal Obama’s signature accomplishment, Republicans now are bearing the brunt of the public’s fickle mood towards the nation’s health care system. It’s rare to hear Republicans mention health care anymore in their ads, while even red-district Democratic candidates (like Conor Lamb in Pennsylvania) have attacked Republicans for backing changes to popular entitlement programs like Medicare.
Polling shows that health care has become the top issue for Democrats, while it has receded in importance for Republicans. This month’s Kaiser health care tracking poll found that more Democratic voters cared about health care (30 percent) than gun control (28 percent) and the economy (23 percent). Only 15 percent of Republicans rank it as their top issue. A separate NBC/Wall Street Journal poll, conducted in April, showed voters trusted the Democratic Party over Republicans on dealing with health care by the biggest margin (40 to 22 percent) in over a decade.
Not all Democrats are convinced health care is a surefire political winner for them. The party’s progressive activists are pushing for a government-run health care program, a position that could doom Democrats in swing, suburban districts. After single-payer-backing Democrat Kara Eastman upset the more moderate former Rep. Brad Ashford in Tuesday’s primary, one Democratic operative told National Journal that the once-competitive race in Nebraska is now GOP Rep. Don Bacon’s to lose. The strategist noted that the Omaha-area district is headquarters to dozens of insurance companies, many of whose employees could lose their jobs if such a radical measure were implemented.
And there’s still a vigorous intra-Democratic debate over whether running to protect Obamacare is a winner in the red-state Senate races that will determine which party controls the upper chamber. Many Senate Democratic strategists believe that criticizing Republicans for inaction on rising health care costs is a clear winner, while others are nervous that relitigating Obamacare is a risky strategy.
But with rising health insurance premiums expected this year amid a reported uptick in the number of uninsured Americans, Democrats believe that Republicans will be blamed for the growing instability in the health care marketplace. Even Trump acknowledged the growing anxiety over health care costs by unveiling a plan to tackle the rising costs of prescription drugs.
In New Jersey, the MacArthur-Kim matchup is emerging as one of the best bellwethers in the country for which party holds the political edge on health care. An April poll, commissioned by an outside House Democratic super PAC, found MacArthur leading Kim by only a point, 42-41 percent. Kim held his town hall at the same venue where MacArthur had been booed exactly one year earlier, and he claims the congressman has been avoiding public events with constituents ever since. “You’ve got to show up; you’ve got to talk to the people you represent. If you are afraid of your constituents, if you’re afraid they’ll give you a piece of their mind, you need to find a different job,” Kim said to applause.
MacArthur, meanwhile, is confident that the tried-and-tested GOP playbook of attacking Democrats for favoring socialized medicine will resonate again. “Andy Kim’s answer is a European-style government-run health care system that will increase taxes and bankrupt Medicare, while reducing coverage for seniors and giving benefits to illegal immigrants,” MacArthur spokesman Chris Russell said. “If he wants to force a fight between his Medicare-for-all idea and Tom’s solutions for the health care system, we would be happy to have that debate.”