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Analysis | The Health 202: Why Republicans don't talk about repealing Obamacare anymore

Democrats are looking to exploit the GOP's failure to deliver on a core campaign promise.


THE PROGNOSIS

House and Senate Republicans (Melina Mara/The Washington Post)

Michigan Rep. Mike Bishop's campaign website doesn’t mention Obamacare, even though Web archives show it once prominently featured promises to vigorously fight the 2010 health-care law.

Rep. Andy Barr of Kentucky touted repealing the Affordable Care Act as one of three top priorities when first running for Congress in 2012. Now his website focuses on tax cuts and job creation instead.

In her first House bid in 2014, Virginia Rep. Barbara Comstock said her campaign was about growing the economy, creating jobs and “repealing and replacing Obamacare.” She’s not talking about that anymore.

For the first time in nearly a decade, these Republican candidates and others across the country find themselves bereft of what was once their favorite talking point: repealing and replacing President Obama’s Affordable Care Act — and all the havoc they alleged it wreaked.

That's because the GOP failed dramatically in its efforts last year to roll back the ACA as its first big legislative delivery on the promise of single-party control of Washington from Congress to the White House. That defeat has quickly turned attacks on Obamacare from centerpiece into pariah on the campaign trail, a sudden disappearing act that Democrats are looking to exploit as they seek to regain power in the midterms.

“Yeah, we probably can’t talk credibly about repeal and replace anymore,” Rep. Tom MacArthur (R-N.J.) told me a few weeks ago.

The “repeal and replace” mantra was a mainstay of Republican campaigns for four straight election cycles, propelling the GOP into the House majority in 2010, the Senate majority four years later and in 2016, helping to keep Republicans in power and elect President Trump.

Getting rid of Obamacare was a proud theme for the GOP and conservative groups, which spent hundreds of millions of dollars beating Democrats over the head with charges the law was unaffordable. Trump repeatedly touted permanent elimination of the bill during the campaign and his first year in office but doesn’t often now mention it.

Eighty-four percent of Republican-affiliated health-care ads in 2014 attacked the ACA, while only 11 percent of Democrat-affiliated ads touted it, according to research by the Kaiser Family Foundation and Kantar Media. Out of 849 unique ads that referenced the ACA that year, 87 percent of them backed a Republican candidate and opposed the law.

But since the dramatic defeat of an ACA rollback bill in the Senate last July, many Republican candidates don’t have much to say about health care at all Instead, if they do talk about health care on the campaign trail, it is only to say they have been able to change pieces of Obamacare — repealing the individual mandate as part of their 2017 tax overhaul, for instance, and the Trump administration’s push to allow plans to be sold that fall short of ACA standards.

“If I were running, I’d tout that,” said retiring Sen. Jeff Flake (R-Ariz.), referring to the end of the individual mandate.

Sen. Jeff Flake (R-Ariz.) walks to the senate chamber. (AP Photo/Jose Luis Magana, File)

A problem for the GOP is that a majority of the public wants to move toward more government control of health care. A Washington Post-Kaiser Family Foundation poll released Friday found 51 percent of all Americans, including 54 percent of independents, support a national health plan.

Armed with such evidence, Democrats are eager to seize the moment after years of defending Obamacare, trying to sell it to a somewhat skeptical public and weathering criticism as premiums spiked and insurers dropped out of the marketplaces. And there is evidence that voters see health care as a top issue heading into the midterms, with a HuffPost-YouGov poll showing that most voters picked health care as one of their top two issues in 2018.

Now, the Democrats don’t have to sell Obamacare. Instead, they can target the widely unpopular repeal-and-replace bills passed by the House and tanked by the Senate, which included banner items like curtailing Medicaid expansion in states that adopted it under the ACA.

“We see health care as one of the defining issues of this midterm election,” said David Bergstein, a spokesman for the Democratic Senatorial Campaign Committee. “Voters are incredibly frustrated and angry at how Republicans have sabotaged the health-care system.”

In October, for instance, the Democratic Congressional Campaign Committee ran ads on MSNBC and CNN targeting now outgoing House Speaker Paul D. Ryan (R-Wis.) and his conference for trying to loosen protections for those with preexisting conditions, allow higher insurance premiums for older Americans and ease lifetime limits on coverage.

The DCCC ran radio ads around the same time in 11 GOP-held House districts also charging Republicans’ health-care approach would “gut Medicaid and treatment for opioid addiction.”

In Florida, where Gov. Rick Scott recently announced his challenge to Democratic Sen. Bill Nelson, the DSCC is going after Scott for reversing his stance on expanding Medicaid under the ACA. “Self-serving Scott doesn’t keep his word,” says one of several Google search ads funded by the campaign arm. “He broke his promise to expand health care. Get the facts.”

Disputes over Obamacare were also prominent in the 2017 Virginia gubernatorial race, where Democrat Ralph Northam stressed his hopes of expanding the state’s Medicaid program and ended up beating his Republican opponent Ed Gillespie by a wide margin.

Now Sen. Tim Kaine (D-Va.), up for reelection in 2018, is punctuating his campaign speeches with support for a government health-care plan as a way of further expanding coverage for Americans. “My campaign is focused on a Virginia that works for all — jobs for all, health care for all, education for all, security for all, equality for all,” Kaine said in Charlottesville earlier this month.

GOP advisers say Republicans should promote their efforts to limit Obamacare, pitching themselves as the party that will lower health-care costs. But they stress that no matter what Republicans say, it needs to be from a new health-care playbook.

“If you’re an elected official, you have to come to the table with more than just that 2016 messaging,” a GOP strategist said.

The National Republican Congressional Committee is betting that some Democrats are moving too far to the left on health care, and ran digital ads against vulnerable Democrats in eight states last August attacking them for supporting a single-payer system.

And other vulnerable Republicans are still arguing they can deliver on the repeal-and-replace promise if voters only sent a few more of their party to Washington.

Sen. Dean Heller (R) is in a tough reelection race in Nevada and ultimately voted for the Senate rollback bill. He argued that the slim Republican Senate majority hamstrung Republicans’ efforts to eliminate Obamacare.

“I think at the end of the day we end up with 53, 54 seats,” Heller told the Nevada Republican Men’s Club on April 3. “If we can do that, then we can repeal and replace and change the ACA as we know it today.”

When I asked Sen. Ted Cruz (R-Tex.) last month whether ditching the law is still a realistic possibility for Congress, he insisted that it is.

“It’s a promise virtually every Republican made to voters,” said Cruz, who is also facing an unusually serious challenge from Democratic Rep. Beto O’Rourke (Tex.). Cruz has made Obamacare opposition a signature issue, even forcing a government shutdown in 2013 over defunding it. Cruz said that he will “absolutely” keep hammering on Obamacare. “We need to finish the job,” he argued.

Stu Sandler, a campaign consultant for Bishop who no longer features a repeal promise on his website, dismissed the changes by saying the new issues page reflects the congressman’s accomplishments. He said Bishop’s position “has not changed” on replacing the ACA. “This new website reflects an update for a congressman who has served for two terms and has worked on several pieces of legislation that have been signed into law and are helping the community,” Sandler said.

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AHH, OOF and OUCH

Health and Human Services Secretary Alex Azar was admitted to the hospital last night. (REUTERS/Leah Millis)

AHH: Alex Azar, head of the Department of Health and Human Services, was hospitalized last night after receiving intravenous antibiotics for an unspecified “minor infection,” according to a statement from HHS. The statement said Azar had been "treated" and was admitted to a hospital for observation “out of an abundance of caution.”

"The statement left many questions unanswered, including the nature of the secretary’s infection, how long he has had symptoms, why a minor infection required IV antibiotics, and whether he is hospitalized in Washington or Indianapolis, where he returns many weekends because his family is still living there," The Post's Amy Goldstein writes. One source told Amy the secretary was “doing fine” and was doing work from the hospital. The source also said Azar had been at his office late last week and was expected to return soon.

(iStock)

OOF: A federal appeals court struck down a Maryland law Friday aimed at stopping companies from hiking prices on old, off-patent drugs. The law was seen as a model for other state-based efforts to block massive price increases, our colleague Carolyn Y. Johnson writes. “The law allowed the state to challenge a drug price increase as unconscionable, and companies could have faced a $10,000 fine or a threat to halt drug sales at the high price,” Carolyn writes. 

The U.S. Court of Appeals for the 4th Circuit ruled the law violated the Constitution as it would have regulated sales outside the state. It had been challenged by the Association for Accessible Medicines, the lobby for the generic-drug industry which includes companies like Mylan, Sandoz and Teva. 

In this 2003 file photo, CanadaDrugs.com Director of Pharmacy Robert Fraser, left, takes Minnesota Gov. Tim Pawlenty, second left, on a tour of the Internet pharmacy CanadaDrugs.com in Winnipeg, Manitoba in Canada. (AP Photo/Ruth Bonneville, File)

OUCH: A Canadian online pharmacy has been fined $34 million for importing unapproved drugs, including illegal cancer medication, into the United States. Canada Drugs has billed itself as a safe alternative resource for cheaper drugs and filled millions of prescriptions, but U.S. prosecutors say the company illegally imports unapproved and misbranded drugs from all over the world and has made at least $78 million through such illegal imports. the Associated Press reports.

The company struck a plea deal with prosecutors last year and on Friday, Montana-based U.S. District Judge Dana Christensen approved sentences including five years’ probation, $29 million forfeited and $5 million in fines. The plea deal also requires Canada Drugs to cease sale of the unapproved and counterfeit drugs and surrender domain names for the websites used to sell them.

HEALTH ON THE HILL

Sen. Cory Gardner (R-Colo.) speaks during a Judiciary Committee hearing. (AP Photo/Alex Brandon, File)

— Trump has promised Sen. Cory Gardner (R-Colo.) he will support congressional efforts to protect states that have legalized marijuana, defusing a months-long standoff between Gardner and the administration over Justice Department nominees, The Post's Seung Min Kim reported Friday. Gardner had said in January he would block all DOJ nominations after Attorney General Jeff Sessions indicated a federal marijuana crackdown in states that have legalized it. Gardner’s home state of Colorado made recreational marijuana legal in 2014. 

Gardner said Trump called him late Wednesday to promise that despite the DOJ memo, the marijuana industry in Colorado would not be targeted. So he's backing down from his nominee blockade. “Furthermore, President Trump has assured me that he will support a federalism-based legislative solution to fix this states’ rights issue once and for all," Gardner said. "Because of these commitments, I have informed the Administration that I will be lifting my remaining holds on Department of Justice nominees.”

OPIOID OPTICS

A homeless man finds shelter under a tarp on a street in Hollywood, Calif. (MIKE NELSON/EPA-EFE/REX/Shutterstock)

There has been a surge in deaths of homeless people as a result of high housing costs, violent attacks, extreme weather, deadly viruses -- and the ongoing opioid epidemic across the country. The problem is affecting all types of cities, large and small, even in locations with relatively low housing costs, our colleague Tim Craig reports in a deep dive published Friday.

The surge in deaths also corresponds with a spike in homelessness overall across the United States that follows a lengthy decline. For the first time in seven years, the Department of Housing and Urban Development estimates an increase in the number of homeless, totaling approximately 554,000 in 2017. The CDC issued a statement in December saying with 19 million Americans facing "housing insecurity, and 28 million without health insurance, the risk of homelessness and poor health is a concern for 1 out of 8 Americans."

And the opioid crisis seems to be hitting the homeless community particularly hard. In New York, drug abuse was linked with one-third of the 311 homeless deaths last year. In several California cities, an outbreak of hepatitis A in the homeless community led to the death of at least 21 people. In Anchorage, 41 homeless people were infected with a strep bacteria outbreak, and three died, between late 2016 and last spring.

A Guerrero Community Police member stands guard at an illegal poppy field, in Heliodoro Castillo, Guerrero state, Mexico. (AFP PHOTO / Pedro PARDOPEDRO PARDO/AFP/Getty Images)

— Nearly all the heroin coursing through American cities comes from one place: Mexico. U.S. authorities have expressed alarm at what they call an explosion of opium poppy in their southern neighbor, The Post's Joshua Partlow reports. Trump has declared that “an astonishing 90 percent of the heroin in America comes from south of the border," based on a federal drug agency assessment, and cited that as one reason to build a giant border wall.

Yet Mexican and U.S. officials have struggled in recent years to answer some basic questions about Mexico’s illegal poppy crop: How much is actually being grown? How much of it is the Mexican government destroying? And how much is being turned into heroin? In response, the Trump administration is intensifying efforts to get a more detailed picture of Mexico's poppy problem, Joshua reports.

"It has begun to supply Mexican authorities with drones and geolocation technology and is funding studies to pinpoint how much poppy is being planted and how much heroin is produced from it," Joshua writes. "The new initiatives emerged from several high-level meetings between Mexican and U.S. officials last year, as well as a trip in July by then-Homeland Security Secretary John F. Kelly, who flew to see poppy fields in Guerrero state with Mexican military leaders, according to Mexican and U.S. officials."

— A few more good reads from The Post and beyond:

Politics

Barbara Bush, former first lady, turns to ‘comfort care’

The 92-year-old former first lady will forego further medical treatment.

Carolyn Y. Johnson

AGENCY ALERT

Capital Business

Pentagon wants to spot illnesses by monitoring soldiers’ smartphones

A Fairfax cybersecurity firm has been awarded a contract to develop an app that can detect health problems.

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Business

200 million eggs recalled after nearly two dozen were sickened with salmonella, officials say

The recalled eggs were sold under brand names such as Great Value, Country Daybreak, Glenview and Food Lion.

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To Your Health

Thousands of pounds of prepackaged salad mixes may have been tainted with E. coli, officials say

A Pennsylvania company is recalling 8,757 pounds of ready-to-eat salad mixes that contain romaine lettuce following an E. coli outbreak that has sickened dozens of people.

Kristine Phillips

MEDICAL MISSIVES

Health & Science

HIV-infected people are living for years, but age-related diseases set in early

Heart, liver, kidney and other diseases may develop earlier than in others the same age.

Marlene Cimons

Health & Science

Can marriage make you sick?

In general, it promotes health. But maybe not if your relationship is troubled or your partner is ill. Here’s why, and what can be done.

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INDUSTRY RX

Why Merck Is Betting Big on One Cancer Drug

Merck is making one of the biggest bets on a single drug in the pharmaceutical industry, a move that is risky but that could, if successful, pay off for the company and cancer patients.

Wall Street Journal

DAYBOOK

Today

  • The Global Health Council holds a briefing on National Youth HIV & AIDS Awareness Day.

Coming Up

  • Johns Hopkins Bloomberg School of Public Health holds a seminar on opioids and addiction on Tuesday.
  • The acting director of the Indian Health Services testifies before the House Appropriations Subcommittee on Interior, Environment and Related Agencies on Tuesday.
  • FDA Commissioner Scott Gottlieb testifies before the House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies on Tuesday.
  • The National Institute for Health Care Management Foundation holds an event on “Stopping the Superbug Threat” on Wednesday.
  • Brookings Institution holds an event on medical marijuana on Wednesday.
  • House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies holds a hearing on the 2019 budget for HHS biodefense activities on Wednesday. 
  • The Senate Appropriations Subcommittee on the Departments of Labor, Health and Human Services and Education and Related Agencies on the budget for HHS on Thursday.
  • The Tatia Oden French Memorial Foundation will host a hill briefing  on two bills on making childbirth safer on Thursday.
  • The Senate Finance Committee holds a hearing on the opioid epidemic on Thursday.
  • The Better Medicare Alliance holds a briefing on improving consumer understanding of Medicare Advantage on Friday.

SUGAR RUSH

Fact Check: Are jails filled with people who only possessed small amounts of pot?

Stephen Colbert jokes all the retiring Republican lawmakers are headed to the same retirement home, "Old White Acres:" 

A look at the royal invite to Prince Harry and Meghan Markle's wedding:

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