Obamacare Politics Are Set to Go Local

The political debate over the Affordable Care Act was the same everywhere. House candidates in California were discussing the individual mandate and coverage for preexisting conditions just like Senate candidates in Kentucky were. Voters viewed the law through a national lens. Until now.

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The political debate over the Affordable Care Act was the same everywhere. House candidates in California were discussing the individual mandate and coverage for preexisting conditions just like Senate candidates in Kentucky were. Voters viewed the law through a national lens.

Until now.

Next year all Obamacare politics will be local. The law's implementation has already been dramatically different from state to state—reading local coverage, it's sometimes hard to believe the same law is taking effect everywhere. That means its politics will also be different from Senate race to Senate race, House race to House race.

The shift will cut both ways: In some instances it will help Democrats; in others, Republicans. But it presents a challenge most pressing for Republicans, who have touted the law as central to retaking the Senate and expanding their already deep majority in the House. If the law's politics are different in every campaign, can the GOP ensure it's a winning issue everywhere?

Nowhere is the emergence of local Obamacare politics more apparent than in an Arizona congressional race. Democrat Ann Kirkpatrick, who represents a sprawling, conservative-leaning district, had heard plenty about the health care law. Nearly every TV ad Republicans ran against her in 2012 featured Obamacare. Already, the National Republican Congressional Committee is running radio ads tying Kirkpatrick—again—to the law.

But this time around, Kirkpatrick has a new rebuttal. Earlier this year, the Arizona GOP ruptured in civil war as one group, led by Republican Gov. Jan Brewer, teamed with Democratic legislators to expand the state's Medicaid program using federal funds from Obamacare. Both state legislators running against Kirkpatrick voted and lobbied against the Medicaid expansion in the Arizona House.

That's given Kirkpatrick an opening. Her district is rural, poorer than average, and has a large Native American population—all elements that Kirkpatrick says will make Obamacare especially positive in her region.

"Anyone who campaigns on repealing the law or opposing Medicaid expansion is really out of step with this district," Kirkpatrick said in June after the state Legislature agreed to expand the state's Medicaid program. "They just don't know the district."

Arizona state Rep. Adam Kwasman, one of the Republicans who voted against expanding Medicaid and is considering a campaign against Kirkpatrick, isn't shying away from a fight. "If she wants to defend a program like that, whoever she runs against: Bring it on," he said.

In some states, even Republican-run governments are expressing some level of buy-in on Obamacare that complicates GOP efforts to brand the law a failure and waste of funds. Take Iowa, for instance, which features a competitive, open-seat Senate race next year. Despite Republican control of the governorship, the state has compromised with the federal government to help set up its own state-based exchange. "While we have varying opinions regarding the Affordable Care Act, we have not let our differences prevent us from meeting our responsibilities and moving Iowa forward," Republican Gov. Terry Branstad wrote in a letter to Health and Human Services Secretary Kathleen Sebelius.

The friendliness of some GOP officials toward Obamacare further weakens the GOP's rhetoric. Rep. David Joyce, R-Ohio, is a top target of Democrats, and an avowed opponent of Obamacare. But his home-state governor, Republican John Kasich, endorsed expanding Medicaid there. And because Kasich is also seeking reelection in 2014, he'll likely tout his own decision to cooperate with the federal health care program even as Joyce takes aim at it.

"Will his criticism put him in the cross-hairs of Kasich, who will be also on the ballot?" said Brock McCleary, a Republican pollster. "That's a fascinating dynamic."

Republicans are convinced Obamacare will ultimately be a net positive for them in every race, even as they acknowledge its politics will vary from one to another.

Take New York, for example, where the iconic grocery chain Wegmans is an upstate staple. The company announced earlier this year it was cutting benefits for part-time workers. The news, similar examples of which can be found in most areas, is the perfect opportunity to show voters how the law is hurting their community, according to Andrea Bozek, spokeswoman for the National Republican Congressional Committee. "Anytime you can take a national issue that is increasingly unpopular and localize it for folks and show voters how it can directly impact about the pocketbook and health care, two things they care passionately about, it's a very effective tool to have," she said.

That emphasis on local stories is doubly important because of the effect it has on local news. In most Senate and House races, voters' attitudes will be shaped by local TV stations and newspapers more than their national counterparts.

Of late, local coverage has been determined by release of the average premium rates for the state-based health care exchanges. And just as with local official reaction and Mediciad expansion, states will offer significantly different premium rates on their health care exchanges (those rates also vary from city to city within a state).

In Utah, a family of four that doesn't qualify for government subsidies would pay $656 for the average insurance plan, according to data released by the Obama Administration; in Alaska, the same family would pay nearly double that, at $1,131. Utah features one of the race's most competitive House races, where Rep. Jim Matheson is poised for a rematch against the woman he narrowly defeated last year, Republican Mia Love. In Alaska, Democratic Sen. Mark Begich is one of the GOP's top targets.

The effect on coverage can be dramatic. At the end of September, readers of Arizona's largest newspaper awoke to a front-page, above-the-fold story—in print and online—touting low prices available on the state's new insurance exchanges: "Arizonans' costs low under new health law."

A few days later, when the exchanges actually opened, the Arkansas Democrat-Gazette and local TV had more unwelcome, if early, news for Sen. Mark Pryor, a Democrat who has staunchly defended the law. A state insurance spokesperson said that Web issues had, to her knowledge, prevented anyone from signing up for health insurance in the first two days of the exchange, a problem plaguing other states with federally run exchanges. A few days earlier, Obamacare's expensive premium rates in the state made the Democrat-Gazette's front page—right next to an adjacent story featuring an enormous photograph of a train wreck, Republicans' favorite metaphor for the law.

Republicans insist the health care law's national unpopularity makes it a political winner. They have a point: Obamacare's popularity is at an all-time low in many surveys. And a problem-filled rollout of the state-based exchanges, a glitch-fest that has left no state unscathed, has renewed GOP hopes that implementation will be the kind of the kind of disaster that will sink Democratic candidates everywhere.

Perhaps, but such confidence belies the significant changes to the law's politics already afoot. A national strategy worked in 2010 and 2012. In 2014, it likely won't be enough.

This article is from the archive of our partner The Wire.