Health care is likely to be a central issue in the 2018 election cycle, and that messaging began within minutes of Thursday’s vote on the Republicans’ overhaul bill.

Now the race is on for both parties to sway voters. 

Groups on both sides of the political spectrum were clearly prepared with ads and statements right after the GOP health care bill passed the House along party lines.

Democrats leaped into action to target vulnerable House Republicans who supported the bill, which they view as disastrous. Republicans jumped to support GOP lawmakers, and make their case that the bill will help Americans. 

Less than 30 minutes after the bill passed, the Democratic Congressional Campaign Committee announced it would be targeting even those vulnerable Republicans who voted against the legislation on the issue. The DCCC launched digital ads on Facebook and Instagram aimed at 30 GOP members.

The ads highlight the Democrats’ message that the bill will result in higher health care costs and fewer insurance protections, and an earlier estimate from the Congressional Budget Office that 24 million people over 10 years would lose coverage if the bill, as originally introduced, became law.

Ready to fight

For Democrats, this vote only galvanizes their already energetic base. 

Massachusetts Rep. Katherine M. Clarke, vice chairwoman of the DCCC’s recruitment team, said Democrats have seen an increase in citizens interested in becoming involved, and they are ready to run.

“We are going to work tirelessly to make sure that every ‘yes’ vote that was cast today has a great opponent waiting for them in November of ’18,” she said.

Outside groups were also poised to attack Republicans. Priorities USA Action, a Democratic super PAC, announced just minutes after the Thursday vote that it would continue its previously announced digital ad campaign in nine states with vulnerable GOP House members.

As the bill heads to the Senate, Democrats are also looking to tie it to the two more vulnerable Republicans up for re-election next year, Nevada’s Dean Heller and Arizona’s Jeff Flake. The Democratic Senatorial Campaign Committee already released Thursday a YouTube pre-roll ad on the bill’s effects. (A pre-roll ad plays before a video selected by a user and is too short to be skipped.)

Senate Democrats face a difficult map in 2018, defending 25 seats compared to the Republicans’ eight. House Democrats would have to gain a net of 24 seats next year to win back the majority. 

Mixed signals

It’s too early to tell if the health care issue will help Democrats flip seats, but Republicans say they are ready to defend their bill and make their case. 

Rep. Greg Walden, one of the key players in the overhaul as chairman of the Energy and Commerce Committee, suggested the bill would not endanger those vulnerable GOP House members facing tough re-elections.

“They’re going to be able to go home and sell this in a positive way,” the Oregon Republican said. Walden is also a former chairman of the National Republican Congressional Committee, the House GOP campaign arm.

For the GOP, the key goal on the campaign trail would be to educate voters about their legislation. Republicans say the bill would result in lower health insurance premiums over time while still protecting coverage for people with pre-existing conditions.

Not all Republicans were convinced that final amendments added to win votes actually improved the bill.

“These amendments are fig leaves, and I feel bad for all the vulnerable members,” said Rep. Ileana Ros-Lehtinen, who voted against the bill. The longtime Florida lawmaker recently announced she would be retiring at the end of her term. 

Rep. Tom Cole, a former NRCC chairman, acknowledged there was some concern about how the bill would affect vulnerable GOP members seeking re-election.

“We know this is a controversial and difficult vote,” the Oklahoma Republican said. “It was for our colleagues when they created Obamacare. So we’ve got to recognize that.”

GOP unfazed

Some GOP lawmakers facing potential tight races say they weren’t fazed by the coming Democratic attacks, since they are already DCCC targets.

“They’ll do that regardless of how I vote on this,” said Minnesota Rep. Jason Lewis. He is one of seven House lawmakers whose re-election contests are rated toss-ups by Inside Elections with Nathan L. Gonzales. 

“It’s intriguing because I really do believe that I won because we made Obamacare an issue in 2016,” Lewis said. He described a collapsing health care exchange market in his home state, and insurers dropping out of exchanges across the country.

“Who would want to run on that?” he said. “I want to fix it and that’s why I’m supportive of this.” Lewis said the key is educating voters about the bill.

Cole said passing the GOP health care bill would help Republicans in 2018 by energizing GOP voters who have been calling on Congress to repeal the 2010 health care overhaul since it became law.

“The Democratic base is whipped up, aroused. Nothing’s going to change on that between now and 2018,” Cole said. “The best defense is having a Republican base that is similarly energized. And you can’t break the promise to them on something as basic and think they’re going to be enthusiastic about turning out.”

Twenty Republicans ultimately bucked their party and voted against the health care bill. Most of them were moderate members of the conference, though a few conservatives also opposed the measure.

When House Republicans were originally attempting to pass the bill in March, President Donald Trump threatened to support primary challengers to GOP members who opposed the legislation. But a Trump ally said that threat no longer existed.

“No one is going to talk about who votes ‘no.’ If they vote ‘no,’ it’s for the individual reasons and makeup of their districts,” New York Rep. Chris Collins said before the vote. “We’re not going to go after anybody because we’re going to celebrate the fact that we’re going to get this passed.”

No new targets

The American Action Network, a group aligned with House GOP leadership, had previously aired ads pressuring vulnerable members to support the bill. Four of the 11 members targeted in those ads voted against the legislation.

But the group says it is not targeting those defectors. Instead, the network announced Thursday that it was making its first post-health care vote television ad buy in 21 congressional districts, encouraging voters to thank members who supported the GOP overhaul. The $2 million ad buy also highlights the benefits of the bill.

Following the vote, the NRCC emphasized that it would still support members who bucked leadership and voted against the legislation. Those ‘no’ votes will also not impact a member’s eligibility for the Primary Patriot Program for dues-paying members facing a credible primary threat.

“No matter where they voted today, the NRCC supports our members and will be behind them 100 percent in 2018 as we continue to expand our Republican majority,” spokesman Matt Gorman said in a post-vote memo.

But while Republicans were gearing up for defense, Democrats wasted no time saying that health care would help them win seats next year.

How confident were the Democrats? Moments after the bill passed, Democratic lawmakers waved at their GOP colleagues across the aisle, singing, “Nah nah nah nah, hey hey hey, goodbye.”