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What's At Stake For U.S. Health Policy With This Year's Midterm Elections


Obamacare won't be on ballots in next month's elections, but the fate of the 8-year-old health care law and other ambitious health care initiatives could be decided depending on which party wins control of Congress. NPR's Scott Horsley reports on what's at stake for health care in the midterms.

SCOTT HORSLEY, BYLINE: Republican strategist Karl Rove recently wrote an op-ed about health care that was headlined "The Sleeper Issue Of 2018." The alarm clock is about to go off. Voters like Lou Hendricks in Kansas City are telling pollsters health care is a defining issue as they get ready to cast their midterm votes.

LOU HENDRICKS: One of the big concerns that we have as a family is making sure that there continues to be coverage for previous conditions.

HORSLEY: Democratic Senator Claire McCaskill, who's in a tough battle for re-election in Missouri, is trying to tap into that concern. McCaskill describes her own struggle with breast cancer in a new campaign ad.


CLAIRE MCCASKILL: I don't talk about it much, but those who face cancer and many other illnesses have a pre-existing condition when it comes to health coverage.

HORSLEY: McCaskill blasts her Republican opponent, Josh Hawley, for joining a lawsuit that seeks to overturn Obamacare and its requirement that insurance companies offer coverage regardless of a person's medical history. Republicans insist they will protect patients with pre-existing medical conditions, though they've been vague in saying how.

Democrats around the country have seized on this issue. Erika Franklin Fowler, who directs the Media Project at Wesleyan University, says health care dominates congressional campaign ads, outpacing jobs, taxes and immigration.

ERIKA FRANKLIN FOWLER: Democrats have been laser-focused on health care this year.

HORSLEY: It's the mirror image of what we saw in past election cycles when, Fowler says, Republicans ran a blitzkrieg of ads attacking Obamacare while Democrats stayed largely quiet.

FRANKLIN FOWLER: Regardless of how Americans feel about the Affordable Care Act, there are provisions of it that are very popular. Once it became clear that those provisions are in trouble, I think that has sort of changed the landscape of how politicians will talk about it this cycle.

HORSLEY: Democrats are determined to protect those popular provisions if they win one or both houses of Congress in November. On the other hand, if Republicans keep control, they could take another run at repealing Obamacare.

Vice President Jessica Anderson of the Conservative group Heritage Action says that could happen during the lame-duck session even if Republicans lose in November.

JESSICA ANDERSON: Many Republicans want the ability to finish the job. They've campaigned on this for over eight years.

HORSLEY: No matter which party controls Congress next year, Anderson says the Trump administration will likely keep trying to chip away at Obamacare. For example, the administration has already relaxed regulations, allowing stripped-down insurance policies with reduced coverage.

ANDERSON: The president will still be in office, and his administration will still be active in trying to find places to roll back harmful regs.

HORSLEY: But Democrats might be able to put the brakes on some of those efforts if they win a majority in November. Drew Altman heads the Kaiser Family Foundation, a health care research organization.

DREW ALTMAN: What you're likely to see is much greater and even fierce oversight of the administration's efforts to change and, many would say, undermine the ACA.

HORSLEY: Lou Hendricks, the voter we heard from earlier, calls himself a fan of the Affordable Care Act even though he's a Republican. Hendricks, who's retired, used to get insurance through his employer. But more and more he's leaning towards a single-payer insurance system which progressive advocates like to call "Medicare-for-all."

HENDRICKS: It makes it easier and simpler for everybody with the exception of Aetna, Blue Cross Blue Shield - enter the medical insurance company here.

HORSLEY: Even if they win a sweeping midterm victory, Democrats won't have the power to pass "Medicare-for-all." But they might jumpstart the conversation ahead of the next election in two years. Scott Horsley, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

Scott Horsley is NPR's Chief Economics Correspondent. He reports on ups and downs in the national economy as well as fault lines between booming and busting communities.