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Healthcare costs, pre-existing conditions remain top midterm battleground issues

A new poll provided more evidence that healthcare and protections for people with pre-existing medical conditions remain key to how American voters will decide whom they want to run their states and represent them on Capitol Hill.

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Those issues also have Republicans who have spent much of their political time and capital over the past eight years trying to repeal and replace the Affordable Care Act — which granted the safeguards against insurers discriminating against patients with pre-existing conditions — shifting their rhetoric and now claiming they are in favor of keeping those protections.

About 71% of U.S. adults surveyed said healthcare was "very important" to them in how they will vote in the Nov. 6 midterm elections, according to a new poll from the nonpartisan, nonprofit Kaiser Family Foundation.

When asked to choose the one issue most important in their voting decision for Congress this year, the largest share of voters, or 30%, selected healthcare over the economy, gun policy and immigration, Kaiser reported.

The poll falls in line with the results of other recent surveys ahead of the midterm elections.

Kaiser's national poll surveyed 1,201 U.S. adults, plus representative samples in Florida and Nevada — two bellwether states with competitive Senate and gubernatorial elections — of 599 voters each.

In Florida, Sen. Bill Nelson, a Democrat, is in a tight race to hold his Senate seat against Republican Gov. Rick Scott. Former Republican Congressman Ron DeSantis is in a close battle to keep the governorship for his party against Democrat Andrew Gillum.

In Nevada, Republican Sen. Dean Heller also is trying to fend off a challenge for his Senate seat against Rep. Jacklyn Sheryl Rosen, a Democrat. Republican Adam Laxalt is running against Democrat Steve Sisolak to be Nevada's governor.

The Cook Political Report's latest rankings put all of those races as toss-ups.

Costs unite voters

While the rankings in the Kaiser poll of issues varied by party — with healthcare being the most important to Democrats, at 40%, versus 31% for Independents and 17% for Republicans — the costs of health services and prescription drugs united all voters.

Among the voters who said healthcare was very important to their decision in choosing a candidate, 24% identified the costs of drugs and services as their key concern, while 19% said it was access to healthcare.

About 28% of voters in so-called battleground areas of the nation said healthcare was their top issue heading into the midterm election, with 22% responding that the economy was the most important.

Of those surveyed in Florida and Nevada, a majority said they were more likely to vote for a candidate who supported maintaining the ACA's protections for people with pre-existing conditions

In Florida, 69% said they were more likely to vote for a candidate who said they wanted to keep the ACA's pre-existing conditions safeguards, versus 9% who said they would vote for someone who wanted to eliminate those protections, regardless of whether it led to increased costs for healthy people.

The response was similar in Nevada, with 68% responding that they were more likely to vote for a candidate who pledged to maintain the ACA's pre-existing conditions protections.

More than half of Americans have someone in their households with a pre-existing condition, according to Kaiser.

Reversing course

After a majority of Americans voiced their opposition to Republicans' efforts to repeal the ACA and end pre-existing condition protections or allow insurers to charge more for those patients, a number of the party's candidates have now backtracked on the votes they earlier cast and their previous years' campaign pledges to dismantle the law, saying they now support preserving its safeguards against discrimination.

Among the most recent Republican lawmakers to reverse course was Sen. Ted Cruz of Texas, who pledged during an Oct. 16 debate that he would defend the pre-existing conditions protections, even though he repeatedly vowed to repeal the entire ACA and sponsored legislation in 2015 aimed at specifically ending the pre-existing conditions safeguards.

When Cruz ran for president in 2016, he promised he would "repeal every word of Obamacare."

Cruz is in a tough race now to hold his Senate seat against Democratic opponent Beto O'Rourke, who called the Texas senator out during the debate on his previous opposition to the ACA.

The reality for Republicans is that "protections for people with pre-existing conditions are now like motherhood and apple pie and opposing them is a political third rail," Larry Levitt, senior vice president for special initiatives at the nonpartisan, nonprofit Kaiser Family Foundation, wrote in an Oct. 17 article in the Journal of the American Medical Association.

But Senate Majority Leader Mitch McConnell, R-Ky., is undeterred, telling Reuters this week that he is prepared to lead another effort to repeal the ACA if his party can retain the Senate and gain more seats, despite Americans' opposition to such an action.

McConnell also told Bloomberg that there was "nothing wrong" with a Republican lawsuit challenging the ACA's constitutionality and is seeking to end its pre-existing conditions protections, saying he does not think it is harming his party's chances in the midterm elections.

A group of Republican senators has introduced legislation they said would ensure that health insurance plans remain available to Americans with pre-existing medical conditions if the lawsuit, which is being fought in Texas, is successful in invalidating those protections.

But Kaiser's Levitt noted that premiums could vary based on age, sex, occupation and lifestyle under the legislation.

The bill is "something of a mirage," because it would allow insurers to use "pre-existing condition exclusions," which means those companies could exclude paying for treatments and services associated with pre-existing conditions, Levitt wrote.