In the more than 2,400 pages of President Barack Obama’s landmark health care law, there are a lot of lists: nutrition labeling requirements, members of various councils and funding for this or that program by a certain fiscal year.

An important list you won’t find buried in the reams of legalese under review by the Supreme Court today: Members of Congress whose vote for the Patient Protection and Affordable Care Act cost them their job.

About two-thirds of Democratic Members who lost in November 2010 voted for the law. This year, Republicans hope they can continue to tie vulnerable incumbents in tossup states and districts to their vote for the unpopular legislation, which would cut about $500 billion from future Medicare spending.

But in 2012, Democrats believe they have a shield to deflect the attacks: House Budget Chairman Paul Ryan’s controversial budget, which would fundamentally change the way older Americans interact with popular Medicare program.

“Republicans want to end the Medicare guarantee,” Democratic Congressional Campaign Committee Chairman Steve Israel (N.Y.) said recently in a statement distilling the Democrats’ argument against Members who have voted in favor of the Wisconsin Republican’s budget.

That’s a message that many top Democratic strategists believe will insulate vulnerable Democratic incumbents from attacks on Medicare cuts in the health care law.

Insulated or not, expect Republicans to hammer home Obamacare attacks. And the messaging won’t just be on Medicare cuts and the “massive government takeover of health care” but will also focus on a key part of the law — the Independent Payment Advisory Board. That panel of 15 unelected experts will make “recommendations to reduce the Medicare per capita growth rate,” according to the law.

Republicans will say the IPAB is a board “that can ration care and deny certain Medicare treatments,” as an ad from the 60 Plus Association said recently.

Top strategists dismissed that line of attack as hooey.

“C’mon, that is just pure political scare tactics,” said influential Democratic pollster John Anzalone. “There is a bullshit meter with voters, and it’s even higher with seniors. … I don’t think [that attack] passes the sniff test.”

Democrats point to the actual wording of the law, which prohibits the board from making “any recommendation to ration health care, raise revenues or Medicare beneficiary premiums.”

Still, the GOP sees the whole health care issue as a winning one.

“None of the things that were terrible about Obamacare [in 2010], are any less terrible today,” GOP consultant Rick Wilson said. “This is the old lesson that a dead fish never smells any better.”

He added: “When you talk about IPAB and things like that, seniors feel a direct threat to their relationship with their doctor, and if Democrats have to defend it, they’re losing.”

As the Supreme Court takes up the constitutionality of the law, the decision could have a huge effect on messaging this cycle, too.

“If any shred of this is unconstitutional, we have a tombstone vote for Democrats and the entire race could be defined by this,” GOP consultant Jeff Roe said.

That is, if Democrats can’t make it about the Ryan plan first.

This is Roll Call’s look at five races in which the health care issue will matter this cycle.

Senate Races

Missouri

Claire McCaskill (D) Vs. Todd Akin (R), John Brunner (R) or Sarah Steelman (R)

Not long before McCaskill voted to finalize Obama’s health care bill into law, she criticized what she called the “Chicken Little” component of Congress.

“We have had a lot of Chicken Little around this building over the last few months: ‘The sky is falling, the sky is falling,’” she said in March 2010 on the Senate floor, noting that the sky didn’t fall.

“As time goes on, people in America are going to realize this bill is not full of booby traps, it is full of good things that will reform health care.”  

Republicans hope that with that vote — and the one that made her the 60th vote for cloture on the Affordable Care Act — McCaskill ensured that the political sky will indeed fall on her this November. And the GOP and its allies will make sure, in a race that already would have been very close, voters know McCaskill was a strong supporter of the deeply unpopular law.

In the summer of 2010, 71 percent of almost
1 million Missouri voters supported Proposition C, which amended the state’s law to prohibit an individual mandate, the key part of the health care law that requires that people get health insurance or pay a fee. While the vote was ceremonial in nature — federal law trumps state law — it showed wide opposition to the law that McCaskill voted in favor of.

She’ll face the winner of a GOP contest between Rep. Todd Akin, businessman John Brunner and former state Treasurer Sarah Steelman. And the victor is sure to hit her on Obamacare.

“When you’re talking about health care, it’s the government takeover and it’s the lack of real impact, especially on costs,” said Randall Gutermuth, a GOP pollster working with Brunner. He noted the latter attack could be particularly potent against McCaskill, who had said a primary reason she supported the bill was to bring down health care costs.

“It’s that she supported this massive government takeover of health care while, at the same time, voting to cut $500 billion from Medicare,” he said.

Akin said that he wasn’t sure health care would be the center of the GOP nominee’s attack against McCaskill but saw it as one place where “she is vulnerable.”

“I think it was very, very bad policy, but it’s also bad politics for Claire McCaskill to double down and support it,” he said.

Democrats pushed back.

“The bigger issue in this race will be Brunner, Akin and Steelman’s desire to slash Medicare, cut benefits and make seniors pay more,” said Matt Canter, communications director for the Democratic Senatorial Campaign Committee. “These candidates will also have to explain to Missouri voters why they want to create new loopholes for insurance companies to discriminate against pregnant women and kick 25-year-olds off their insurance.”

Akin was a strong and vocal supporter of last year’s Ryan budget and supports this year’s version as well. Both change the Medicare program in a substantial way that Democrats will frame as “ending Medicare as we know it.”

In a contest that could come down to a few thousand votes, the debate over the health care law — and the Ryan budget — could decide the winner.

Wisconsin

Tammy Baldwin (D) Vs. Tommy Thompson (R), Eric Hovde (R),
Mark Neumann (R) or Jeff Fitzgerald (R)

A contentious August GOP primary will determine who faces Baldwin, a staunch supporter of the Affordable Care Act who supported a single-payer government health plan. Whether that nominee is businessman Eric Hovde, former Rep. Mark Neumann or state Speaker Jeff Fitzgerald, Baldwin’s left-of-center position on health care is likely to be an issue.

If, however, the GOP nominee is former Gov. Tommy Thompson, the health care law might play a bit differently in the general. Thompson, a former secretary of Health and Human Services, says he doesn’t support the law and never has, but his conservative detractors, including the Club for Growth, gleefully point to circumstantial evidence showing his apparent backing of at least big portions of it, including openness to the individual mandate. Perhaps most politically potent is a photo of him that was posted on the White House website after the law was passed. It depicts a smiling Thompson next to Secretary of Health and Human Services Kathleen Sebelius and other top Democrats.

Darrin Schmitz, a senior consultant to Thompson, said in a statement that the former governor supported reform because the health care system was broken. “But when bipartisan talks broke down he publicly stated his opposition to what eventually became Obamacare,” Schmitz said. “Thompson believes that Obamacare must be repealed and replaced … [and any] insinuation that Gov. Thompson has ever been in favor of Obamacare is absolutely false and a reflection of the desperation of the source.”

One Wisconsin Democratic strategist scoffed at the idea Thompson has always been against the law. “The ballet dance he is trying to do here is not going to fly in a Republican primary,” the source said.

On Friday, Neumann obliquely hit Thompson in a statement. “I’ve always been against all forms of Obamacare; from its first drafts to today,” he said.

Baldwin will have her own hill to climb on health care. There is a video of her from 2010 in which she says, “I actually was for a government takeover of health care, I was for a single-payer plan!” Expect to see that in a 30-second spot run against her in the general.

But she’ll use her personal story about illness as a child and having an insurance company deny her coverage, alongside what she’ll frame as a career fighting for affordable and accessible health care for all, to fight those attacks.

And there will be strong Democratic pushback on the Ryan budget against whoever the GOP nominee is in this race.

Massachusetts

Elizabeth Warren (D) Vs. Scott Brown (R)

Health care won’t decide this race, but it’s hard to see how it won’t be an issue. Brown rode his pickup truck and a promise to be the 41st vote blocking health care reform to an upset special election victory in January 2010. Right before he was sworn in, he told Barbara Walters that he thought the whole health care plan should be scrapped and Congress should start from scratch.

He voted for the law’s repeal, and aides said he still opposes the law and feels that health care should be left up to the states. Warren supports the law, although there is no mention of it by name on her website. Her platform trumpets some of its more widely supported measures.

Part of what makes health care a unique issue in this race is that the national law was heavily based on the Bay State’s health care legislation, which Brown voted in favor of and then-Gov. Mitt Romney, the likely GOP White House nominee, signed into law. That means issues such as the individual mandate — which is in both laws — shouldn’t be a point of contention in the campaign.

Still, Brown and Warren both see areas in which to ding each other on the Affordable Care Act.

If the Supreme Court decides parts of the laws are unconstitutional, watch for Warren to emphasize how important it will be to have a Democrat voting for Supreme Court justices. That could be a potent fundraising pitch, if one that doesn’t swing that many voters. And while she supports the law, Brown won’t be able to knock her for having voted for “unconstitutional Obamacare.”

If the court upholds the Affordable Care Act, the issue may fade in this race as the election nears.

House Races

Pennsylvania’s 12th district

Jason Altmire (D) Vs. Mark Critz (D)

This Member-vs.-Member primary pits Altmire against Critz, two opponents of health care reform who didn’t vote to repeal the law. In the nasty race, Critz will attempt to make health care an issue by threading the needle about how and what each candidate opposes in the Affordable Care Act.

Big unions back Critz, who won a special election two months after final passage of health care but said he would have voted against the bill. Altmire voted against the legislation.

The differentiation between the two comes in whether they voted to fund various aspects of the law. Critz’s team believes Altmire’s vote to “defund” the insurance exchanges is an important contrast.

“Jason has voted to make the law worse; Mark believes it needs to be made better,” a Critz aide told Roll Call. “It is going to be a major issue.”

In an interview, Altmire slapped down the idea that there was any real  difference between the two.

“They’re getting into the weeds,” he said, noting that the vote in question was on the discretionary nature of funding exchanges. “I haven’t found at all that this is an issue back home,” he said. “What he’s trying to do — this is a Democratic primary, so he’s trying to act like he’s for the [law] in a Democratic primary, but he wasn’t. Everybody knows what he did in his campaign,” Altmire said. “You can’t go back and change the facts.”

The winner of the primary will face presumptive GOP nominee Keith Rothfus.

Health care may be an issue in the general, but when voters are tuned in to the race, the airwaves will be so full of presidential ads that there might be too much noise for either candidate to burn in his own messaging on any issue.

New York’s 24th district

Dan Maffei (D) Vs. Ann Marie Buerkle (R)

Maffei was unseated by Buerkle in 2010. He has the distinction of being one of the few Members who voted for the health care law, was voted out of office and now is trying to come back.

In his rematch, Maffei will have the advantage of a slightly more Democratic district than the one he lost in two years ago. And while he has the early edge in the race, the albatross of his health care vote will most definitely still be strung around his neck over the next eight months.

Just ask his opponent.

During the 2010 elections, “the health care law was the most controversial” of Maffei’s votes, Buerkle said. “But at that time, because it had just been passed, I don’t think anyone [fully] understood the problems that were going to come to pass once the law started to be enacted. This time around, it will play a larger role.”

Maffei, through a spokesman, declined to discuss health care with Roll Call.

In an extensive interview on the law, Buerkle ticked through a number of aspects of Obamacare she sees as negative. “The cuts to Medicare and Medicare Advantage, that’s probably one of the most damaging pieces of this along with the creation of the IPAB board,” she said.

Buerkle admitted that the prohibition on denying insurance to people because of pre-exisiting conditions and letting children stay on their parents’ health insurance until they are 26 were “good.”

Confronted with the fact that she voted to repeal those aspects of the law along with the rest of it, she said: “Whenever you vote on something, you weigh the good and the bad. … I think there’s no question that the burdens in this health care law far outweigh the good that was done.”

The freshman lawmaker said the good aspects of the law could be put in a more incremental piece of legislation that wouldn’t amount to a government takeover of the sector.

Democrats will note that Buerkle’s vote to repeal the law would have ended many of the publicly supported parts of the health care law, but their trump card will be her vote for the Ryan plan last year and, likely, this year as well. “She voted to end Medicare. Twice,” the messaging will go.

Buerkle, of course, vehemently rejected that interpretation of Ryan’s “Path to Prosperity.” She insisted the Ryan plan was something that “doesn’t affect seniors.”

“It doesn’t affect anyone who is 55 years and above. That’s very different than the health care law,” she said.

Democrats dispute that contention. And because the budget won’t be passed by the Democratic Senate, we’ll never really know.

“The challenge in modern politics is people can say whatever they want and there really isn’t much of a referee,” Maffei told Roll Call in an interview last year.

He’s right. As so often happens in politics, the truth on health care is lost somewhere amid the hyperbolic poll-tested messaging. But seniors across the 24th district, if they believe the ads they’ll see on TV, will have to choose between a Congressman who gutted their Medicare or a Congresswoman who voted to end it.

That’s a hell of a choice.