What the Health-Care Vote Means for the Midterm Elections
Democratic senators in battleground states are likely to face GOP challengers that voted for the ACA overhaul
WASHINGTON—This week’s expected Senate vote on the GOP health-care bill will showcase a sharp partisan divide on the issue in states where Democrats are poised to play defense in next year’s midterm elections.
All Senate Democrats are expected this week to oppose Republican legislation that would dismantle and replace much of the Affordable Care Act. Many of their potential challengers in next year’s elections are House Republicans, who supported a similar bill when it passed their chamber in May.
Such a stark partisan divide, while the norm across much of the country, is unusual in the most competitive states held by Democratic senators. The 10 Senate Democrats up for re-election next year in states won by President Donald Trump comprise much of the shrinking pool of centrist Democrats who are willing to cross the aisle on high-profile votes.
The group includes Heidi Heitkamp of North Dakota, Joe Manchin of West Virginia, Bob Casey of Pennsylvania, Claire McCaskill of Missouri and Joe Donnelly of Indiana
Some of these red-state Democratic senators, for example, voted to confirm some of Mr. Trump’s most contentious cabinet nominees and his staunchly conservative pick for the Supreme Court. They also have broken rank on energy policy and gun-control legislation.
Although many of these Democratic senators have been critical of the ACA, none have endorsed the GOP’s approach to dismantling it.
The partisan split forced by the health-care votes presents a clear political test in these battleground states: Will the ACA’s enduring unpopularity, especially among conservatives, boost those who voted to overhaul it? Or will recently rising support for the ACA, and the public’s skepticism of the GOP alternative, help those who sought to block Republicans’ efforts?
It may come down to which health plan voters dislike more. Candidates on each side appear to be spending more time disparaging the other party’s bill than praising their own.
“Based on my initial review, the health-care bill released by Republican leadership appears to be as bad of a deal for West Virginia as the House bill,” Mr. Manchin said last week. “This bill makes things worse, not better.”
Their stance may in part reflect that the ACA was already a more centrist law than the single-payer government-run system that more-liberal Democrats had hoped to pass, said Gabriel Horwitz, vice president for the economic program at Third Way, a centrist Democratic think tank.
“Its bones are moderate. It’s all about a private-sector solution,” Mr. Horwitz said of the ACA. “If you’re a red-state Democratic member, you’re saying, ‘I support a moderate piece of legislation.’”
In the most recent Wall Street Journal/NBC News poll, just 16% said the House-passed version of the bill was a good idea. The 2010 health-care law, often referred to as Obamacare, was viewed as a good idea by 41% of respondents.
The gap is likely more narrow in red states, however, where Republican leaders dispute the notion that the ACA is “moderate” and have spent years campaigning on their pledge to roll it back.
Republicans currently hold a slim 52-48 advantage in the Senate, and the party that controls the White House often suffers in midterm elections. However, far more Democrats than Republicans are in precarious seats in 2018, and how the health debate plays out in those states could be pivotal to the outcome of the contest for the Senate.
In six of the most competitive Senate seats held by Democrats up for re-election next year, nine possible House Republican opponents have already voted for the GOP health-care legislation.
The House bill was backed by possible Senate challengers GOP Reps. Todd Rokita and Luke Messer of Indiana, Ann Wagner and Vicky Hartzler of Missouri, Mike Kelly and Lou Barletta of Pennsylvania, Kevin Cramer of North Dakota and Fred Upton of Michigan. GOP Rep. Evan Jenkins of West Virginia has already announced he will challenge Mr. Manchin next year.
The Senate Democrats could also face challengers from outside the House, depending on the results of GOP primaries. Those candidates will likely get pressed on how they would have voted on the GOP health-care bill.
The Senate health-care bill headed to the floor this week has much of the same basic architecture of the House bill, though it contains a more gradual phasing-out of the Medicaid expansion and altered tax credits to help people buy health insurance if they don’t get it through work.
One complicating factor for House Republicans with statewide ambitions is that Mr. Trump himself called their bill “mean” in a meeting with Senate Republicans earlier this month. He has told lawmakers he supported making the Senate bill more generous.
“I agree with the president,” Ms. McCaskill said last week. “I look for opportunities to agree with the president, and I agree with him on that one.”
House Republicans noted that Mr. Trump had invited them to the Rose Garden for a press conference touting their victory the day it passed in May. “The president clearly embraced the work of the House. He pushed hard for the House passage of a bill,” Mr. Jenkins of West Virginia said Friday.
Others said they viewed Mr. Trump’s comments as strategic.
“One more time he’s proven he’s not the traditional, stereotypical politician,” said Mr. Cramer of North Dakota. “If this is his way of playing senators, I’m all for it.”


