A few short years ago, Kim Adams couldn’t have told you the name of her representative in Congress.
That changed last year, when Republican Rep. Mimi Walters voted to repeal the Affordable Care Act as Adams watched live on C-Span from her home in Tustin. News cameras showed a smiling Walters taking a celebratory selfie in the White House rose garden after the vote on the Obama-era healthcare law.
That, Adams said, made things personal. After she was diagnosed with multiple sclerosis in 1999, Adams lost her small business as her health deteriorated and she eventually got to a point where she could no longer afford her health insurance premiums. For three years, the single mother was uninsured and unable to get treated for her MS — until the Affordable Care Act kicked in. And her congresswoman had voted to take it away.
“I told people, she's got a bull's-eye on her back now from me,” Adams recalled. “I understood the deep and lasting ramifications of repealing that and the millions of Americans that would undergo the same kind of devastation I did.”
In this midterm season with the control of the House and the fate of the Affordable Care Act at stake, Adams is telling her story to everyone who will listen. She’s told it in online videos, in a newspaper op-ed and in front of crowds in Pershing Square in downtown L.A. She spoke at a healthcare roundtable in Florida, and flew to Pennsylvania to work on a congressional campaign there.
She’s one of the many people taking part in the changing conversation over the healthcare issue. As the Affordable Care Act’s provisions have become reality and the GOP repeal effort threatened to take insurance away from people who were benefiting from it, the law known as Obamacare has gone from a political hot potato for Democrats to a Republican liability heading into the midterm elections. Polls have shown voters nationwide say they consider healthcare to be the most important issue as they head to the ballot box.
"The threat of this law being repealed crystallized in some peoples' minds how valuable it really is," said Gerald Kominski, a UCLA health policy and management professor and senior fellow at the school's Center for Health Policy Research.
Kominski, who worked on the rollout of the healthcare exchange in California, said that until last year's GOP effort, "the debate and the discussion about repeal and replace was all kind of hypothetical. Now it's become a real possibility that this law is going to be repealed."
Democrats, targeting vulnerable Republican members of Congress nationwide and in several hotly contested races in California, are making healthcare the centerpiece of their effort to wrest control of the House. Republicans in competitive races are no longer trumpeting their efforts to repeal Obamacare, even professing support for popular parts of the law they demonized for years, as opinions on the law have begun to shift.
Many voters in several hotly contested congressional districts in Southern California say they know, or know of, someone who would be bankrupt, seriously ill or dead were it not for the healthcare law. Those people are speaking up at rallies, appearing in campaign videos and talking to neighbors in these battleground districts, putting a face to what was once an abstract, amorphous government bureaucracy with unknown consequences.
Brandon Zavala of Antelope Valley is one of those faces. He was 12 when his mother died of a heart condition he says routine tests could have caught. He says he didn't connect the dots as a teenager but later came to realize that if she had been able to afford insurance she could have lived far past age 37.
Now, 13 years later, Zavala is on doorsteps and phone lines, telling the story of how his parents decided to forgo their own health insurance to save money, while keeping their two sons’ coverage. Their finances were stretched thin because Zavala’s brother was starting college, and a family history of dementia and diabetes meant high premiums, he said. About a year after she went without insurance and visits to the doctor, his mother collapsed in the family’s living room.
“I started realizing it wasn't an accident, it wasn't a mistake, it wasn't God calling her home,” he said. “No. We didn't have health insurance and she couldn't get the bloodwork she needed.”
This election cycle, Zavala has organized rallies, trained volunteers and launched canvasses to get his congressman, Rep. Steve Knight (R-Palmdale), booted out of office for his vote to repeal the healthcare law. Zavala supports Knight’s opponent, Democrat Katie Hill, who has talked about the importance of affordable healthcare. Hill also has firsthand experience — her husband had a medical emergency while he was uninsured between jobs and ended up $200,000 in debt.
“I'm not going to equivocate on the idea that if you make quality healthcare harder, you should lose your job,” Zavala said. “I will never forgive the Republican Party for creating an environment where more 12-year-olds have to bury their mother.”
Eight years ago, in the month leading up to the 2010 midterm elections, when the healthcare overhaul was a hot-button issue fueling the rise of the tea party, 44% of Americans said they had an unfavorable view of Obamacare, compared with 42% who viewed it favorably, according to a Kaiser Family Foundation tracking poll.
Last month, the foundation’s poll found that 49% viewed the law favorably and 42% said the opposite.
For four weeks in September and October, 46% of political ads in federal races mentioned healthcare, according to the Wesleyan Media Project. Democrats, riding the new popularity of Obamacare, were much more eager to tout their positions on healthcare, bringing it up in more than 54% of their ads.
That’s a dramatic shift from the 2010 midterms, when more than a third of Republican ads mentioned healthcare but less than 10% of Democratic ones did.
House Minority Leader Nancy Pelosi (D-San Francisco) and Sen. Charles E. Schumer (D-N.Y.) said in a statement last month that “Democrats are focused like a laser on health care,” President Trump, they said, “is desperate to change the subject from health care to immigration” because he knows it’s a losing issue for them.
Republicans are scrambling to shore up their healthcare platforms by vowing to protect people with preexisting conditions if the Affordable Care Act is repealed and replaced, embracing a marquee protection of the health law they have been trying to get rid of for years.
In September, with just over a month to go until the election, Knight sponsored a bill to maintain protections for preexisting conditions, joined by a slew of vulnerable House Republicans including Walters and Rep. Dana Rohrabacher (R-Costa Mesa). The website GovTrack gives the bill a 4% chance of being enacted.
Rohrabacher, who voted more than 50 times to repeal the Affordable Care Act, said in an ad that he supports forcing insurance companies to cover preexisting conditions. The 15-term congressman who is in a tight race for reelection, voted for a Republican healthcare bill that the Congressional Budget Office said would have made insurance prohibitively expensive for such people.
Shana Charles, an assistant professor in public health at Cal State Fullerton, said the shift in attitudes toward healthcare was most apparent in how Republicans are now echoing some selling points of the Affordable Care Act. Charles lives in Orange County’s 39th Congressional District, where Republican Young Kim is locked in a tight battle with Democrat Gil Cisneros over Rep. Ed Royce’s House seat. Kim was a longtime aide to Royce, who voted to repeal the Affordable Care Act.
"Someone like Young Kim, when you listen to her campaign commercials, she sounds like someone who always loved the ACA,” Charles said. “That's the language that they've moved to.”
Charles said in the early days of the Affordable Care Act, the prevailing sentiment was one of fear and confusion, without a clear counternarrative against Republican attacks. In this election cycle, people are publicly calling attention to what access to healthcare has meant in their own lives, she said.
Leonard Musgrave, a 76-year-old retired test engineer and full-time political junkie, might as well be saying “I told you so.”
The longtime registered Republican — the only Democrat he remembers voting for is John F. Kennedy — wrote in a letter to the editor published in the Orange County Register in March 2017 as the GOP repeal effort gathered steam: “Republicans are going to commit political suicide by trying to repeal and replace Obamacare.”
“They should just wait until it collapses on its own. … But who ever said the Republicans were that smart?” Musgrave, who lives in Orange, wrote at the time.
Musgrave, who spends his days listening to political talk radio as he does woodworking in his garage, said he’s sensed the change in how people talk about the Affordable Care Act.
“It’s probably got to the point where people are living with it and it’s maybe working out for them. I don’t hear a lot of people complaining about it,” he said. “It kind of mellowed out.”
That hasn’t changed his mind — he remains just as concerned about the mounting national debt and fears the Affordable Care Act made it worse. As for which side has it figured out on what to do about healthcare, he has little confidence in the whole lot.
“I don’t think either one of them know what to do to solve the problem,” he said. “It’s something they can talk about and throw around.”
Musgrave lives in California’s 45th District, a longtime Republican stronghold, where Walters’ challenger, Katie Porter, is pushing the envelope on the healthcare debate by campaigning in favor of a government-funded universal system.
At a healthcare town hall at UC Irvine’s medical school last month, Porter, a consumer protection attorney, said that when she worked in bankruptcy courtrooms in the early 2000s, she saw families whose lives had changed overnight after a health emergency.
“If you have unlimited money, you already have universal healthcare in this country,” she told the crowd of medical students and voters. “Make no mistake — this election is about the future of our healthcare system.”
Adams certainly see is that way. With treatment for her MS and the depression that came with it, the 56-year-old is healthier now. But she lives with the physical reminders of the three years her disease went untreated — permanent nerve damage in her right eye, leg and foot. More devastating to her is the thought of what her daughter went through in her early teenage years.
“I lost three years of being able to care for my daughter, worrying the whole time, living in constant panic,” she said. “I lost those years of my life.”
In December, she went to Washington to lobby Walters in person. She met with an aide to the congresswoman instead, but didn’t believe her message got through.
So now she’s focused on making herself heard by talking to those with the power to vote Republicans out of office.