Trump jumps into the Nevada Senate race — ground zero in the midterm fight over Obamacare

  • President Donald Trump heads to Nevada, where the Affordable Care Act is perhaps the most important issue in a pivotal Senate race.
  • GOP Sen. Dean Heller, who voted for a bill to repeal parts of Obamacare after pledging to oppose an earlier version, is facing a tough re-election bid against Democratic Rep. Jacky Rosen.
  • Nevada saw a massive decrease in its uninsured rate after it expanded Medicaid under the health care law.
President Donald Trump (R) gestures towards Sen. Dean Heller (R-NV) (L) while delivering remarks on health care.
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President Donald Trump (R) gestures towards Sen. Dean Heller (R-NV) (L) while delivering remarks on health care.

As he pushed Senate Republicans to repeal the Affordable Care Act last year, President Donald Trump zeroed in on Sen. Dean Heller.

When the president had lunch with GOP senators in July 2017, the Nevada lawmaker sat directly to his right. A month earlier, Heller had joined Republican Gov. Brian Sandoval in pledging to oppose a GOP version of Obamacare repeal that would phase out Medicaid expansion. That piece of the 2010 health-care law boosted insurance coverage for low-income people in Nevada.

Trump said he "worried" about Heller's vote and nudged him to support repeal. The president turned to Heller and quipped, "He wants to remain a senator, doesn't he?" Days later, Heller supported a different Republican proposal to roll back large parts of the health-care law, which failed on the Senate floor by only one vote.

Now, Heller's vote is the biggest point of contention in Nevada's deadlocked Senate race this year. The Republican's rival, Democratic Rep. Jacky Rosen, has repeatedly hammered Heller over GOP attempts to dismantle Obamacare. Her message embodies a broader effort by Democrats locked in Senate battles to defend a law that hindered the party in elections only a few years ago.

Trump heads to Las Vegas on Thursday for a rally in part meant to boost Heller's re-election bid. A Trump campaign stop puts Heller in a difficult spot as he tries to win a state Democrat Hillary Clinton carried in 2016. The senator will need support from the rural GOP voters loyal to Trump, but the president also risks energizing voters who oppose Obamacare repeal and associate Heller with it.

The president plans to stay overnight in Nevada and attend a fundraiser for a committee benefiting Heller, GOP House candidate Danny Tarkanian, and Republicans' House and Senate campaign arms, according to Jon Ralston, editor of The Nevada Independent news outlet.

Rosen has "absolutely" made health care the top issue in her campaign, said David Damore, a professor and chair of the political science department at the University of Nevada, Las Vegas. Damore said Heller's vote last year "hurts him," not only because Democrats can criticize him on policy but also because they can cast him as a "political opportunist" or "waffler."

Democrats across the country have tried to motivate voters by casting a GOP majority as a threat to health-care coverage. The party has seized on the Trump administration's support for a lawsuit that would gut pre-existing conditions coverage — litigation GOP senators have tried to distance themselves from with a proposal to shield those protections. Vice President Mike Pence also gave Democrats more ammunition last month when he said Republicans would continue their efforts to repeal Obamacare next year with a GOP majority.

Health-care coverage data after Obamacare's passage show why Heller opposed repeal at first — and why Rosen has hit him over his change of heart. From 2013 to 2016, Nevada's uninsured rate among nonelderly people fell by nearly 12 percent, according to the Kaiser Family Foundation. The drop was the largest of any state, and more than double the median decrease in all states that expanded Medicaid.

In a statement, Heller campaign spokesman Keith Schipper contended Rosen has "done nothing" on health care while Heller "has tried to find solutions to lowering the cost of health care and protecting pre-existing conditions." The Democratic representative "hopes nobody will ask her what she's done," he added.

Heller has tried to distract from a "toxic" and "reckless" health-care agenda by claiming Rosen has not worked to make health care more affordable, Rosen campaign spokeswoman Molly Forgey contended. She said Heller "broke his promise to protect Nevadans' health care" and has "turned into a spineless rubber stamp for the White House."

Rosen voted against the House GOP's Obamacare repeal plan last year, as well as the Republican tax plan that rolled back the health-care law's requirement that most Americans buy health insurance or face a financial penalty. The House repeal bill would have led to an estimated 23 million more Americans without insurance by 2026, primarily because of Medicaid changes, according to a Congressional Budget Office estimate.

Rep. Jacky Rosen, D-Nev.
Bill Clark | CQ-Roll Call Group | Getty Images
Rep. Jacky Rosen, D-Nev.

Insurance figures for the states where this year's 10 most competitive Senate races will take place further illustrate why Democrats have focused on health care. The uninsured rate in Montana — where Democratic Sen. Jon Tester has defended Medicaid expansion and pre-existing conditions coverage as he faces a tough re-election bid — dropped more than 10 percent from 2013 to 2016.

Rep. Kyrsten Sinema, who aims to win a GOP-held Senate seat in Arizona, has also pledged to protect her state's expansion of Medicaid. Arizona's uninsured rate fell more than 7 percent from 2013 to 2016. Sinema opposed the House GOP plan to repeal Obamacare, while her opponent, Republican Rep. Martha McSally, voted for it.

Those races along with the contest in Nevada will help to determine whether the GOP can keep or expand its 51-49 majority in the Senate — and potentially pursue more changes to the health-care system. Republicans have the advantage: while Democrats and independents who caucus with them have to defend 26 seats this year, Heller's is one of only nine GOP seats up for grabs.

Nevada race is a dead heat

Public polls in the Nevada contest so far show a dead heat. Heller has an advantage in the fundraising race, another key indicator. At the end of June, his campaign had $5.8 million on hand, versus $3.8 million in the bank for Rosen's campaign.

More outside spending has come from anti-Heller groups than anti-Rosen forces. Organizations led by the pro-Democratic Senate Majority PAC have shelled out about $9 million against Heller, according to the Center for Responsive Politics. Groups including the pro-GOP Senate Leadership Fund have spent more than $5 million opposing Rosen.

Democratic groups have used their ads to drill into Heller's health-care record. The Democratic Senatorial Campaign Committee, Senate Democrats' campaign arm, this week unveiled an ad featuring a cancer patient saying Heller "broke his promise" to protect health-care coverage and "caved" to political pressure.

Earlier this year, the Senate Majority PAC released an ad criticizing the Republican senator for his shifting stance on health care.

Rosen's biggest challenge is motivating voters in Las Vegas and the surrounding areas who benefited from Obamacare, UNLV's Damore added.

"Making that linkage is tough to do," he said. "They've done a pretty good job with it in terms of making it a salient issue, and also as a reflection of Heller's character."

Heller's campaign has largely deflected from the GOP senator's record on health care. Instead, it has tried to portray Rosen as a politician who has talked about addressing health-care costs without taking concrete action.

If Trump brings up health care during his visit, he could upend that strategy. The president could simultaneously remind the GOP base that Heller went against his wishes at first – and refresh Democratic voters' memories about the senator's subsequent vote to repeal parts of Obamacare.