Voters consistently rank health care as their top political concern. What does that mean for Minnesota’s House races?

Ask any candidate for Congress in Minnesota this year about health care, and they’re almost certain to tell you it’s one of the most important issues in their districts — if not the single most important issue.

Opinion polling backs that up: a recent CBS News poll found that 70 percent of Americans think health care is a very important issue, a larger share than any other top issue. A similar conclusion has been reached by plenty of other polls conducted over the last few months, which also find that health care is foremost in voters’ minds, even above the economy and headline-grabbing topics like immigration.

Just because seemingly everyone agrees health care should be a top focus, though, doesn’t mean they agree on what parts of the issue to focus on: for the most part, Democratic and Republican candidates are telling voters very different stories when it comes to the politics of health care.

In Minnesota and elsewhere, Democrats are making health care a central part of their pitches to voters: they argue that President Donald Trump and Republicans, if left in charge in Washington, will pass legislation that limits people’s access to care, and in particular endangers those with so-called “pre-existing conditions.”

For evidence, Democrats are pointing to the GOP’s failed 2017 legislative push to repeal and replace Obamacare — a campaign that may have ended up making the embattled health care law more popular than ever. Many Democrats hope that sentiment is one of the factors that will fuel a “blue wave” and deliver them control of Congress.

After running for years on promises to get rid of Obamacare — a strategy that led them to big wins in the 2010 and 2014 midterms — most Republicans are now running away from their repeal-and-replace crusade. Instead, the GOP is seizing on the growing popularity of single-payer health care among Democrats to make the case their opponents are eyeing an even bigger and costlier “government takeover” of health care.

The stakes of the health care battle are high: Whoever wins control of Congress in November will be tasked with fixing a U.S. health care system that is growing costlier and increasingly untenable.

Radinovich embraces single-payer; Craig more cautious

The races in Minnesota’s 2nd and 8th Districts, two important battlegrounds, illustrate in stark terms the dynamics on health care that are playing out in Minnesota and around the country.

Joe Radinovich, the DFL candidate in the 8th District, is running hard on health care, and he’s putting his support for a single-payer health care system in the spotlight. His opponent, Republican Pete Stauber, won’t say that Obamacare should be jettisoned outright, but he’s quick to raise alarm over what Democrats like Radinovich might do if they get a chance to push single-payer in Congress.

Radinovich has called health care the most important issue to CD8, going so far at a debate on Wednesday to say it was of “existential” importance. “To me, it’s very clear we’re at a breaking point on this issue,” he told MinnPost. He slammed the GOP repeal-and-replace plan, entitled the American Health Care Act, saying it would make health insurance more expensive or unattainable for the 300,000 people in CD8 he said have some kind of “pre-existing condition.”

The 32-year old former state legislator from Crosby is the only Democrat running in one of Minnesota’s battleground U.S. House races — Districts 1, 2, 3, and 8 — who is in favor of single-payer. “People are losing ground. When I have an opportunity to talk to folks to make the case for single payer, it becomes apparent to many people,” he said.

“I don’t feel like I’m taking a lot of heat on it,” he said. “I’m not poll-testing my positions to determine whether I should hold them or not.”

While Radinovich is running ads touting his stance on health care and going after his opponent, Stauber is putting less of a spotlight on the issue. “Of course, it’s a very important issue,” he told MinnPost. “I think we have to get it right… The entire federal government taking over our health care, I don’t think that’s the way to go.”

Stauber, a St. Louis County commissioner, conceded that there were good things about the Affordable Care Act, pointing to coverage for people with pre-existing conditions and allowing individuals to stay on their parents’ health plan until age 26. He did not say he would work to repeal Obamacare, but added that if the law were the answer to health care problems, “we wouldn’t be talking about it now.”

“I do know that the health care proposal by my opponent, which consists of a $33 trillion government takeover, will be detrimental.”

In the 2nd District, health care is a defining aspect of the contest between GOP Rep. Jason Lewis and DFL challenger Angie Craig. Lewis, a freshman congressman and former right-wing radio personality, was a key vote in favor of the AHCA when it passed the House by a slim margin last year. Craig is making his vote a central part of her case for why CD2 voters should replace Lewis, arguing that the congressman wanted to blow up the health care system for “political reasons.”

“The bottom line is, Republicans talked for years about repealing and replacing the ACA,” she told MinnPost. “They offered no solutions, and they got control of the House, the Senate, and the presidency, and they’ve done nothing to address the rising cost of health care since that moment in time.”

Craig, a former executive at the medical device firm St. Jude Medical, is not an advocate for single-payer: she doesn’t think it is affordable, and is instead in favor of measures to stabilize the individual insurance market established by the ACA.

As the general election heated up, Lewis’ camp said that the congressman wouldn’t shy away from talking about health care, no matter the bad rap the AHCA got. In an interview with MinnPost, the congressman blamed Democrats and the media for spreading misinformation about the Republican repeal and replace plan, and for “scar[ing] people into thinking this reform is going to deny them health care.”

“For all the slings and arrows, this was reform that was long overdue, reform that would have had the greatest benefit for the greatest number,” he said. “The challenge for us is getting the truth out. The lie does get around the world faster than the truth gets out the door.”

Lewis argued that at St. Jude Medical, Craig lobbied in favor of the ACA but is not taking responsibility for the current problems in the health care system. “The people who now say, we all agree things need to be fixed, that isn’t what you all agreed to two years ago, or eight years ago,” he said. “No one said this was a first step. No one predicted the tripling of premiums and copays, the dropping out of insurance companies, other than folks like me.”

An ‘overwhelming Democratic issue’

Despite the confidence of candidates from both parties on health care, there are signs that Democrats have an edge when it comes to the issue, according to some observers and public opinion polls.

Robert Blendon, a professor of public health and politics at Harvard University, said that “health care this year is an overwhelming Democratic issue.”

“When you ask registered voters which party is better on health care, it’s overwhelmingly the Democrats,” he told MinnPost. “It’s switched from this very strong, significant anti-ACA feeling.”

Blendon pointed to several polls indicating not only that people are putting health care front-and-center this election, but that they trust Democrats to handle the issue better than Republicans. That CBS News poll from September, for example, found that just 12 percent of voters surveyed believed they were helped by Republicans’ actions on health care.

In September, the pro-Obamacare advocacy group Protect Our Care commissioned Democratic polling firm Public Policy Polling to survey voter attitudes about health care in Minnesota’s 2nd and 3rd Districts. In CD2, 48 percent of voters trusted Democrats to handle the health care issue versus 45 percent for Republicans. In CD3, where GOP Rep. Erik Paulsen is trying to defend a strong challenge from Democrat Dean Phillips, 56 percent of voters trusted Democrats more on health care, versus 38 percent for Republicans.

Those same polls found that pluralities of CD2 and CD3 voters were less likely to vote for Lewis and Paulsen after their votes in favor of the GOP plan to repeal and replace Obamacare. Forty-six percent of CD2 voters said the vote made them less likely to support Lewis, and 54 percent of CD3 voters said the same for Paulsen.

“The Republicans have a double problem here: one is for years they said they were going to repeal and replace [Obamacare] with something better but they never had anything better,” Blendon said. “Also, they have a problem that for their own base that wanted a major change, they never delivered.”

With voters generally more favorable toward Obamacare this year than in the past, some conservatives are suggesting that GOP candidates tone down the repeal rhetoric. Jason Flohrs, director of the Minnesota chapter of Americans for Prosperity, the Koch brothers-backed conservative advocacy group, said “the best strategy for Republicans is to focus on some of these concrete reforms that can be done” — such as legislation to expand health savings accounts — “rather than trying to go point-by-point and have a perfect replacement for Obamacare.”

Nevertheless, Democrats are saying that if Republicans retain their majority, they will inevitably take another pass at repealing Obamacare. Andy Slavitt, who ran the Centers for Medicare and Medicaid Services under Obama and supports DFL candidates in Minnesota, said that “people should understand that, as soon as Trump and the Republicans have the votes, they’re going to vote to repeal the ACA again, no matter what it is they say.”

“For the next six weeks, you’re going to see a lot of people trying to put their vote for repeal as far out of constituents minds’ as possible,” he said.

Ultimately, Republicans are likely to talk about the health care issue less often than Democrats in this election cycle. The president believes that immigration is the GOP’s strongest issue, and many House Republicans are leaning on the stronger economy — which they argue has been fueled by their 2017 tax cut package — to convince voters to keep them in charge in D.C.

With public opinion seemingly on their side, Democrats could ride health care politics to majorities in Congress, observers say. There’s precedent: In 2010, conservative outrage over Obamacare fueled a historic 63-seat gain for Republicans in the House.

Blendon says that health care will be just one of the things that fuels a Democratic “blue wave,” if that ends up happening on November 6. “It’s gonna take a number of issues, because the blue wave requires young voters and members of minority communities and people who are independent and not interested in polls to come out,” he said. “I don’t think a single issue alone will do that. But I think health care would be one of the issues where there’s a blue wave.”