Health Care Crowds Out Jobs, Taxes in Midterm Ads

Once mum on health care, Democrats are hammering the issue in political ads as GOP attempts to tout tax cuts and economy

By Brian McGill and Julie Bykowicz

 Eight years ago, the newly passed Affordable Care Act was so widely criticized that it contributed to Democrats losing control of the House of Representatives. But in this midterm election, health care is the party’s most-mentioned topic in advertising—far above anything else, including opposition to President Trump.

Meanwhile, Republicans—who have made repealing the Affordable Care Act one of their top advertising messages since the 2010 election—are barely mentioning it this year, after the GOP-led Congress tried unsuccessfully to overturn the law last year. The party has instead turned its attention to touting the tax legislation Mr. Trump signed into law late last year.

The Wall Street Journal analyzed Kantar Media/CMAG advertising data on health care and tax and economic messaging in all House and Senate races from Jan. 1 to Sept. 30. Here is what campaign ads tell us about how the political conversation is changing.

Health Care

In 2010, about 29% of Republican political ads targeted the ACA while fewer than 6% of the Democrats’ ads did so—and even the Democratic messaging was split between positive and negative messages.

In the 2014 midterms, 44% of Republican ads attacked Obamacare while 31% of Democratic ads mentioned the issue.

In 2018, nearly 50% of Democratic ads mentioned health care. On the Republican side, just 21% of messages address the issue. In the 29 House districts rated as tossups this election by the nonpartisan Cook Political Report, only three Republicans are running ads on health care. And among all health-care ads from candidates and political groups of both parties, 39% don’t mention the ACA.

The Democrats’ embrace of health-care messaging, eight years after all but shunning it, reflects the growing popularity of the Affordable Care Act as its provisions have come into effect. The percentage of Americans who hold favorable views of the law has surpassed the share opposing it, a gap that has grown since Republicans’ failed repeat efforts.

An ad by Elissa Slotkin, a Democrat seeking to oust Republican Rep. Mike Bishop in Michigan, illustrates the approach many Democrats are taking on health care this year: homing in on popular protections in the ACA for people with pre-existing conditions while avoiding explicit references to the law itself.

Discussing her mother’s death from breast cancer, Ms. Slotkin says in the ad that a pre-existing condition had made treatment unaffordable.

Democrats’ messaging strategy has left some Republicans trying to craft countermessaging that assures voters they, too, are willing to protect the ability for people with pre-existing conditions to get affordable coverage. For example, Republican Missouri Senate candidate Josh Hawley—criticized by opponent Sen. Claire McCaskill for joining a lawsuit as the state’s attorney general to stop the Affordable Care Act—says in an ad that he supports forcing insurance companies to cover pre-existing conditions.


After passing a major tax cut last year, Republicans vowed to make it the centerpiece of their midterm messaging and use it to retain majority control in Congress. Party strategists, however, were stunned to discover in a Pennsylvania special election that the issue didn’t strongly motivate voters. In the last weeks before the March vote, Republicans dropped a discussion of taxes from their ad campaign. While it is the top issue for GOP advertising in the midterms now, it isn’t a dominant one.

About 30% of Republican ads mentioned taxes, compared with about 13% of Democratic ads. But Republicans seem reluctant to talk explicitly about the tax legislation; just under 12% of all Republicans’ television ads mention it. One Republican who isn’t shying away from the legislation is Rep. Erik Paulsen of Minnesota, the most endangered Republican member of the tax-writing Ways and Means Committee. About 37% of pro-Paulsen ads feature a message about taxes, well above the GOP’s 30% average.

Hot Buttons

Health care dominated the airwaves for Democratic candidates during this year’s primaries. Republicans chose to air ads emphasizing GOP tax cuts and aligning with President Trump.

The gap in tax messaging appears to be narrowing. From January to August, which included much of the primary races, the GOP accounted for 59% of advertising that mentioned taxes. In August, that dropped to 55%, as Democrats began increasing their tax-related messaging in the general election.

he parties are highlighting different aspects of the bill. Democrats are talking about the tax cuts granted to corporations and wealthy individuals, wile Republicans are emphasizing tax cuts for the middle class.

David Shapiro, a Democrat seeking a Florida House seat, joined with the Democratic Congressional Campaign Committee to buy an ad highlighting Republican Rep. Vern Buchanan’s role in the tax legislation—and how, the ad says, he personally benefits from it.

Rep. David Young, an Iowa Republican seeking to fend off a Democratic challenger in what has become a tossup race, is emphasizing the tax law’s benefits to families and small businesses.

Jobs and the Economy

Despite a roaring economy, neither party is investing much ad time in convincing voters that that is a good reason to vote for or against anybody.

Just 17% of Republican ads mentioned the economy and jobs, while 15% of Democrats touch on those issues. The upshot: nearly 84% of campaign ads do not mention them.

It might seem that a strong economy would be a great issue for Republicans, but history shows that the economy tends to be a bigger influence on voters when it’s bad. Voter concern peaked after the stock-market crash and recession that began in 2008.

But with the general election now under way—the unofficial kickoff was Labor Day—both parties are ramping up their messaging about jobs and the economy.

The Shifting Political Conversation

The turnaround on health care, with Democrats drilling into it and Republicans largely walking away, is also happening with gun issues in political advertising, the Journal previously found.

And this election has shown something else very rare: the birth of a new political issue, opioids.

— Anthony DeBarros and Dante Chinni contributed to this article.

Write to Julie Bykowicz at






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