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In a Shift, Healthcare Dominates Midterm Election Campaign Ads

As the November midterm elections approach, healthcare is a top focus in campaign advertising.

According to a study by the Wesleyan Media Project, which tracks television advertisements for House and Senate races by state and topic, references to healthcare increased in August. The study found that 37 percent of all ads in August for federal races mentioned healthcare,  including references to both “ACA/health reform” and the more general “healthcare,” compared to 32 percent in the period between January 1, 2017 and July 31, 2018.

The study also found great variation across states and parties.

In August, 52 percent of pro-Democratic ads referenced healthcare, while only 21 percent of pro-Republican ads did so. And while in Georgia, Louisiana, Maine, and Connecticut, 100 percent, 100 percent, 94 percent, and 91 percent, respectively, of ads that ran in August referenced healthcare, none of the ads that aired in Maryland, New Mexico, Oregon, Utah, Rhode Island, and Vermont did.

The data reported does “not cover local cable buys, only broadcast television, national network and national cable buys.”

Democratic groups are spending big on digital ads that heavily emphasize healthcare.

The Senate Majority PAC (SMP), which has been “the top outside spender for either party on ads” this cycle, according to NBC News, and another PAC, Priorities USA, announced that they will jointly spend “$21 million in digital advertising targeting Senate races in nine states,” with ads focused on health care in Arizona, Florida, and Missouri.

Also, Priorities USA and the House Majority PAC recently announced “an eight-figure digital ad program in more than 40 House districts,” that “revolves around health care, taxes and money in politics.”

There is good reason to think healthcare ad spending is a worthwhile investment. According to USA Today, a Kaiser Family Foundation poll found that for “[m]ost Democratic and independent voters – as well as about half of Republicans voters . . . a candidate’s position on preserving protections for people with pre-existing conditions is either the ‘single most important factor’ or a ‘very important’ factor in their vote.”

The survey also found that pre-existing conditions is “the top campaign issue for voters living in battleground areas such as Florida.” And with opinion polls showing many more favoring the Affordable Care Act than opposing it, Democratic candidates and strategists see healthcare as “front and center” this election cycle. David Bergstein, spokesman for the Democratic Senatorial Campaign Committee, acknowledged that “[w]e see health care as the defining issue of the 2018 midterms.”

This demonstrates a shift in campaign ad focus from previous elections.

This midterm election cycle’s heavy focus on healthcare “comes as more liberal Democrats push forward with their own costly ‘Medicare for All’ agenda as a means to counter Republican efforts to undermine former President Obama’s health care law,”reported CBS. This comes after many failed attempts by Republicans to finally achieve repeal of the ACA  and GOP promises “that if they won control of the White House, they’d make the dream of full repeal come true.”

And as Politico stated, “Democratic groups are intent on making the midterms a referendum on health care.”

As CNN said, “[i]n 2010 Democrats were skipping town halls to avoid voters’ rage over impending changes to health care. Now, in ad after ad, they are all about health care.” In August, the New York Times discussed how “‘[r]epeal and replace’ was the centerpiece of many Republican campaigns for four cycles, and one of the most unifying positions among Republican voters.” And just this past week, the New York Times reported again that “[t]his cycle, even Democrats running in red states are putting health care at the center of their campaign messages.”

This trend among Democratic campaign ads “stands in contrast to a more diffuse message on the GOP side,” with “Republicans and the GOP-leaning groups [dividing] their ad dollars on a broader set of issues.”

According to HuffPost, “[a]nti-Obamacare ad spending in the 2018 election cycle has plummeted compared to the same period in the previous three cycles, according to data compiled by Kantar Media/CMAG for HuffPost,” and “Republicans are giving up on Obamacare repeal as a campaign issue.”


This trend is being seen across the country. According to a spokesman for the Democratic Congressional Campaign Committee, Tyler Law, “We’re seeing candidates in every single district talking about healthcare . . . There is nowhere this does not play.” And the September 14 edition of NBC’s weekly campaign ad watch, which highlights recent television ads, referred to healthcare as “the number one issue among [Democratic] candidates,” pointing to recent ads in Michigan and New York discussing healthcare.

Not only is the topic of healthcare becoming more pervasive in campaign ads, but the subject matter itself is changing. A recent article in Roll Call discussed how candidates are speaking more candidly about their personal health challenges, and pointed to candidates all over the country who have opened up about their personal history with cancer.

“Candidates have filmed ads this year in which they’re breastfeeding, sharing stories of sexual assault, opening up about post-traumatic stress disorder, or recalling a scary diagnosis,” wrote Simone Pathé. “They’re showing aspects of themselves that at one time might have been seen as politically disqualifying. And in doing so, they’re hoping that those experiences can be political strengths.”

Rebecca Friedman

Rebecca Friedman

Rebecca Friedman graduated from Harvard Law School in 2019. Prior to becoming a Student Fellow, she participated in the Health Law and Policy Clinic with HLS' Center for Health Law and Policy Innovation. At the time she completed her Fellowship, Rebecca planned to work at Charlotte Center for Legal Advocacy in Charlotte, North Carolina as an Equal Justice Works Fellow sponsored by Kilpatrick, Townsend & Stockton LLP. There, Rebecca will provide direct representation to Medicaid beneficiaries experiencing legal challenges as North Carolina transforms its Medicaid system to managed care, and will work to ensure that Medicaid beneficiaries facing legal issues as a result of social determinants of health receive appropriate support. As a Petrie Flom Center Student Fellow, Rebecca studied the potential for Medicaid to cover doula services and analyzed how racial and socioeconomic disparities in prenatal care and childbirth could be mitigated as a result. The current title of Rebecca’s paper is “The Feasibility and Potential Impact of Broader Medicaid Coverage of Doula Services on Racial and Socioeconomic Disparities in Birth Outcomes.”

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