To:    Interested  Parties

From:    Leslie Dach, Chair, Protect Our Care

Brad Woodhouse, Executive Director, Protect Our Care

Date:    November 14, 2018

Re:     A Look Back at Election Day 2018 and a Look Forward to Health Care in 2019 ————————————————————————————————————————————————

By focusing like a laser on Republican efforts to repeal and sabotage the Affordable Care Act, Democrats were able to make health care the most important issue in the 2018 midterm election and as a result take over the House and deliver key wins in the U.S. Senate and statehouses. In addition, Medicaid expansion proved to be a potent issue for voters who approved ballot measures to expand the program in three states and elected Medicaid-friendly governors in several more more.

The bottom line: last Tuesday voters sent a clear message to their elected officials, particularly Republicans, that the GOP war on health care must end and that their relentless repeal and sabotage agenda must stop.  They sent Democrats to Washington and to state houses across with a clear mandate — protect the affordable care act, block republican sabotage, reduce health care costs and increase coverage and protections.

Health Care Was the Most Important Issue to Voters, Fueling a Democratic Majority in the House of Representatives

According to national exit polls, voters said health care was the most important issue by a two-to-one margin compared to the second most important issue, immigration, 41 percent to 23 percent, and Democrats won those voters 77 percent to 22 percent. Among the competitive GOP-held districts, Democrats had an 8 point advantage on health care, 52 to 44 percent. When it comes specifically to protecting people with pre-existing conditions, voters preferred Democrats over Republicans by a 24-point margin, 58 percent to 34 percent.

Let’s not forget why this happened. On May 4, 2017, the Republican House of Representatives passed a bill to repeal the Affordable Care Act, which would have ripped health coverage away from millions of people, raised health costs for working families by double digits, imposed an age tax on older Americans, slashed Medicaid, and gutted protections for people with pre-existing conditions – all while giving big insurance and pharmaceutical companies hundreds of billions of dollars in tax breaks. It was the most unpopular major piece of legislation Congress had considered in decades. And when that legislation was rejected by the Senate, instead of accepting the will of the people, President Trump and House and Senate Republicans doubled down and turned to sabotage and the courts to repeal health care.

Health Care Was a Big Driver for Women and Independent Voters Particularly

Health care particularly resonated with women and Independent voters. 67 percent of women and 62 percent of Independents said health care was very important or the most important issue. Women trusted Democrats over Republicans on health care 56 percent to 40 percent. Independents trusted Democrats over Republicans on health care 57 percent to 35 percent.

Health Care a Key Factor in the Arizona and Nevada Democratic Senate Victories and Propelled Other Vulnerable Democrats to Victory —  Stopping Republicans From Their Plans to Take Over the Senate

The 2018 Senate map overwhelmingly favored Republicans. Of the 35 races, 26 of them were held by Democrats. Ten Democratic senators were facing re-election in states President Donald Trump won in 2016. The map was so lopsided that right after the 2016 election, some mused Republicans could potentially reach a filibuster-proof 60 seats.

That prediction did not happen. In fact, Democratic senators in Pennsylvania, Wisconsin, Michigan and Ohio easily won their re-elections while senators in West Virginia and Montana held onto their seats too. Thus far, Republicans only defeated incumbent Democratic senators in Missouri, Indiana and North Dakota. There is currently a recount happening in the Florida senate race.

However, Democrats were able to limit these Republican wins by picking up Republican-held seats in Nevada and Arizona. And the reason: health care. An exit poll conducted for Protect Our Care in Nevada found that health care was the top issue for voters in that state — 65 percent of voters said health care was the most important or very important issue — and those voters picked Democrat Jacky Rosen over Republican Dean Heller 68-28. Not to mention Sen. Dean Heller was a co-sponsor of the Republican health repeal bill in the Senate, and that hurt him. Only one-third of voters said his support for repeal made them more likely to vote for him, while 42 percent said it made them less likely to vote for him.

In Arizona, health care defined the race between Democrat Kyrsten Sinema and Republican Martha McSally. As the Arizona Republic reported, “Sinema made [health care] the centerpiece of her campaign from the outset. Everywhere she went, she reminded people of her votes to maintain the Affordable Care Act, the eight-year-old federal law commonly referred to as Obamacare, which Republicans have tried to repeal or roll back.” It worked. McSally told Sean Hannity before the election that she was getting her “ass kicked for it right now” because of her vote to repeal the Affordable Care Act.

So, for all the talk about huge Republican gains in the Senate this year, Republicans may only end up netting one seat.

Medicaid Won at State Houses Across the Country, and 500,000 People Will Gain Health Coverage As a Result

Medicaid was a big winner from the 2018 elections as well. Voters in three states that had not expanded Medicaid previously voted overwhelmingly to expand the program, and by significant margins. Idahoans approved the ballot measure to expand Medicaid with 61 percent of the vote. In Nebraska, it was 53 percent of the vote. And Utah voters approved the ballot measure with 54 percent of the vote.

Moreover, Democratic wins in several gubernatorial races mean that lawmakers will most likely expand the program, having defeated candidates who had opposed expansion.

In Maine, Governor-elect Janet Mills pledged to expand Medicaid, which Mainers had approved in 2017 but Governor Paul LePage had been refusing to do.

In Wisconsin, Governor-elect Tony Evers defeated Governor Scott Walker. Evers made Walker’s refusal to expand Medicaid an issue in the 2018 race.

In Kansas, Governor-elect Laura Kelly made Medicaid expansion a big part of her campaign. The Kansas legislature had passed a Medicaid expansion bill in 2017 but Governor Sam Brownback vetoed it.

As a result of these actions in states across the country, 500,000 people will gain health coverage.

The Road Ahead: An End to the GOP War on Health Care and a Democratic Agenda to Lower Costs and Expand Protections and Coverage  

The message from the 2018 election is this: Republicans must end their war on health care and Democrats must deliver on protecting and improving the Affordable Care Act with a focus on lowering costs and expanding protections and coverage.

While a Democratic majority in the House of Representatives means the GOP’s legislative repeal agenda is effectively over, threats to our health care remain.

The Trump Administration is continuing to brag about its efforts to sabotage the Affordable Care Act. They are pushing short-term “junk” plans that allow insurance companies to deny coverage to people with pre-existing conditions. They cut outreach efforts for the open enrollment period that ends on December 15th.

The President went to court to overturn protections for pre existing conditions  — taking protections away from 130 million Americans — and a decision by a Republican appointed judge is expected any day.

If Republicans continue on this path, this week’s elections show voters are more than ready to hold them accountable.

Instead, voters want the 116th Congress to protect the Affordable Care Act, stop Republican sabotage, lower health care costs and increase protections and coverage.  And they want states to prevent Trump sabotage within their own borders.

Americans want lower health care costs by:

  • Allowing Medicare to negotiate for lower prices for seniors and taxpayers
  • Providing more help for people to afford their premiums and deductibles
  • Ending surprise bills
  • Stopping drug companies from raising prices on critical medications just because they can

Americans want an end to sabotage including:

  • A ban on junk plans that can deny you coverage altogether or charge you more for the care you need when you get sick
  • Fully funding and enthusiastically supporting open enrollment
  • Support for a more stable insurance market rather than efforts to undermine it
  • Robust oversight of the Trump Administration’s sabotage efforts and its cozy relationship with drug industry lobbyists

Americans want Medicaid and Medicare strengthened, not gutted:

  • An end to HHS waivers that put paperwork like so-called work requirements in the way of deserving and eligible Americans receiving Medicaid
  • An end to the relentless efforts to cut funding for Medicare and Medicaid to pay for Republican tax breaks for the wealthy and corporations including insurance and drug companies.
  • Administration support for efforts to expand Medicaid in states where it hasn’t been and approval of waivers to make coverage more accessible.

The Continuing Role of Protect Our Care

Protect Our Care was formed in the aftermath of the 2016 election that saw Donald Trump, who ran on ripping the Affordable Care Act apart, elected President.  With Trump in the White House, and Republicans in charge in the House and the Senate, Protect Our Care was, in advocacy terms, the ultimate Hail Mary pass. With many writing the ACA’s obituary, our purpose seemed to be relegated to extending the life of the law as long as we could and making Republicans pay a political price for ultimately repealing it.

But the spring of 2017 told a different story. The Women’s March signaled a new resistance and a town hall spring was all about health care. Protect Our Care translated that energy into the defeat of repeal in Congress.

In the year since, and throughout 2018, we worked to make voter’s concern about health care into the dominant issue in 2018. Our efforts took our work to more than half the states, including an 11,000-mile, 24-state bus tour and work on the ground in dozens of competitive House and Senate races.

In 2019, Protect Our Care remains fully committed to the fight to protect our care. We will continue to hold Republicans accountable for their repeal and sabotage agenda, and devote our resources to pushing legislative action to reduce costs, and increase coverage and protections. Our health care war room, our ears-to-the-ground government affairs team, our network of consultants and operatives leading our efforts in the states, our digital operation and our deep and strategic investments in public opinion and message research will continue unabated.