BISMARCK - North Dakota Democrats are rallying behind popular provisions of the Affordable Care Act as a key election year issue after years of being pummeled by Republicans over the Obama-era health care law.
Democrats have opened a multi-front defense of the law in recent weeks, urging Republican office-seekers to call off attacks that they warn would harm protections for pre-existing medical conditions. The effort appears to reflect a nationwide trend among Democrats running for office but is especially striking in a state that has consistently voted for candidates who oppose the health care law.
The debate carries perhaps the most weight in the U.S. Senate race, where Democratic Sen. Heidi Heitkamp and Republican Rep. Kevin Cramer came out on opposite sides of failed efforts to undo the Affordable Care Act last year. Heitkamp has called for reforming what she described as an imperfect law, while Cramer has backed so-called "repeal and replace" efforts.
In a meeting with the Forum of Fargo-Moorhead's editorial board this week, Heitkamp recounted a Valley City forum held Monday, Aug. 6, that was intended to be about rural development.
"Almost every person to a letter brought up health care," she said. "You know why (Democrats) are talking about health care? Because every place we go, people talk about health care."
The debate has also bled into the race for North Dakota attorney general and the state's lone congressional seat. It prompted former Democratic U.S. Rep. Earl Pomeroy, who blames his 2010 defeat on his vote in favor of the law, to return to North Dakota to sound the alarm over what he deemed Republican efforts to undermine the ACA.
Republicans, meanwhile, appeared content to allow Democrats to hammer on the Affordable Care Act, commonly referred to as Obamacare, which they blame for higher premiums in recent years.
"I'm fine with them defending policy that North Dakotans don't like," Cramer said, later accusing Democrats of spreading "crazy" claims on the subject. "They are so far on the wrong side of history."
National polling from the Kaiser Family Foundation suggests candidates' views on pre-existing condition protections are "at least very important" to most voters, while views on the ACA itself remain split. North Dakota House Minority Leader Corey Mock, D-Grand Forks, said people tend to be more supportive of individual provisions rather than the entire law when it's branded as "Obamacare."
Bo Wood, a political science professor at the University of North Dakota, said last year's legislative battles may allow Democrats to position themselves as defenders of the law's popular parts.
"I suppose it makes some sense for the Democrats to try to say, 'If you want that to stay, you need to put us in office,'" he said.
Cramer has said he supports protections for pre-existing conditions, although a bill he supported last year would have allowed states to waive certain protections, said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation. Cramer's campaign disputed that and argued the waivers allowed "for alternative ways to accomplish coverage for pre-existing conditions with the state."
Cramer called Heitkamp's opposition to ACA repeal bills a "top tier" issue even as his campaign ads focus instead on tax cuts that Heitkamp voted against, veterans issues and Social Security. He predicted Congress will make another run at health care if Republicans maintain their majorities.
Heitkamp highlighted health care as an example of Cramer looking more "for a political issue than for policy solutions."
Meanwhile, the Trump administration has taken several steps of its own that critics argue amounts to sabotaging the law and could drive up premiums. The Department of Justice said in June it would not defend provisions of the ACA in litigation brought by Texas and 19 other states, including North Dakota.
The plaintiffs in that case argue that because the tax penalties for individuals who don't obtain insurance were repealed last year as part of the Republican tax cut legislation, the entire Affordable Care Act has been rendered unlawful. North Dakota Democrats have focused much of their recent ire toward Republican Attorney General Wayne Stenehjem for joining the lawsuit.
David Thompson, a Grand Forks attorney who's challenging Stenehjem as a Democrat, filed an open records request Monday seeking information about the state's involvement in the case. The next day, Democratic legislators publicized a letter urging Stenehjem to withdraw from the lawsuit.
The letter, signed by minority leaders in the state House and Senate, argued the ACA is "not perfect" but Congress bears the responsibility for fixing problems with the law.
Stenehjem said the lawsuit could force Congress to act and it would still go on even if he did back out.
"I have an overriding duty to support and defend the Constitution," he said.
Heitkamp called the lawsuit "ill-advised" while Cramer said he supports it.
"Democrats need an incentive to come to the table and try to fix this thing," he said.