Associates at Community Health Center wear buttons during a session to enroll people in the nation's new health insurance system Oct. 1, 2013, in New Britain, Conn.
Photo by Jessica Hill/AP

The red state Democrat’s guide to Obamacare

Updated

So, you’ve decided to run for office as a Democrat in a red state!

Whether you’re a longtime incumbent or a first-time candidate, your first task will be figuring out how to handle that health care law President Obama signed in 2010. Perhaps you’ve seen it come up in the attack ads outside groups are running between Seinfeld reruns, for example, or maybe you’ve noticed your opponent has taken to mentioning it every other sentence.

Well, you’re not alone. Many Democrats are reading the same state polls showing Obama’s approval rating underwater and voters just as unhappy with the health care law, even if they’re not always sure how it affects them. After reviewing their various responses, msnbc has compiled this primer to help you choose the Obamacare strategy right for your state.

“Repeal” bad, “fixes” good

Obamacare isn’t popular. But the dominant Republican position, which is to repeal Obamacare entirely and then – maybe – replace it with some as-yet-unspecified law, consistently polls poorly as well – even in red states.

A new poll out this week by Democratic firm Democracy Corps found this was true in Republican congressional districts, too, with 54% of respondents favoring a plan to “implement and fix” the law versus 42% who backed “repeal and replace.”

Not surprisingly, Democrats in GOP-leaning states have overwhelmingly adopted the “implement and fix” approach in their rhetoric.

“They’re not going to repeal it, it’s just not going to happen,” Democratic Sen. Mark Pryor of Arkansas told voters in August. “At some point, you have to decide, OK, are we going to continue beating our head against a wall or are we going to try to make this law work better?”

You could even team up on it. Democratic Sens. Mary Landrieu of Louisiana, Heidi Heitkamp of North Dakota, Joe Manchin of West Virginia, and Mark Begich of Alaska co-authored an op-ed in Politico Magazine suggesting various tweaks to Obamacare, such as allowing people to buy cheaper and less generous plans on health care exchanges, instead of outright repeal.

Landrieu also ran a television ad promoting her effort to pass follow-up legislation that would allow people whose previous plans were  cancelled under Obamacare to renew their coverage. 

Play to your strengths

Obamacare as a whole isn’t well liked by voters, but one reason that a repeal of the law polls so poorly is that a lot of its components are popular individually. If you’re going to discuss Obamacare, it’s probably a good idea to emphasize those parts of the law over less voter-friendly provisions, like the new requirement that Americans purchase insurance.

“I am running as someone who wants to fix the things that are broken in the health care system and build upon the things that are good, including ensuring that people who have preexisting conditions have access to health care, that kids up to age 26 have the opportunity to be covered by their parents,” Georgia Senate candidate Michelle Nunn told Time Magazine in March, name-checking two policies that even some Republican candidates say they support in theory.

In a more aggressive move, Put Alaska First, a super PAC supporting Begich, recently ran an ad featuring a cancer survivor that focused on the law’s ban on discrimination against patients with pre-existing conditions. Maybe someone has a similarly inspiring story in your own state?

Medicaid is your friend

Is your governor denying hundreds of thousands of low-income residents access to the law’s Medicaid expansion? That might be a good thread to pull.

In Louisiana, Republican Gov. Bobby Jindal’s approval rating is at 40%, and polls have shown that voters strongly support accepting federal money tied to Obamacare in order to expand Medicaid. So Landrieu is making the Medicaid issue a centerpiece of her campaign against GOP opponent Bill Cassidy.

”I think Bill Cassidy is going to be at a distinct disadvantage,” Landrieu told The Washington Post’s Greg Sargent this week. “He has insurance, but he’s also denying it to the 242,000 people who fall into the Jindal gap.”

In Arkansas, Democratic Gov. Mike Beebe used the Medicaid money to fund an expansion of private insurance instead. Now Democrats are using the resulting increase in coverage to attack likely GOP Senate nominee Tom Cotton, who has run into trouble defending his repeal position in that context.

 If you can’t say anything nice, don’t say anything at all

Perhaps your voters prefer the strong, silent type instead. You could take a lesson from Kentucky Democratic Senate candidate Alison Lundergran Grimes, who has avoided talking about Obamacare when possible, even though her state is considered the law’s biggest success story.

Grimes doesn’t mention Obamacare on her campaign website’s “issues” page at all, even as it makes reference to unrelated health care policy six times. Plenty of others are doing the same: The Huffington Post found that the majority of 2014 Democratic Senate candidates don’t mention the law on their campaign sites, either.

Well, if I had been there…

If you’re an incumbent who voted for Obamacare, you’re going to have to defend the law at some point. But if you’re a first-time candidate or if you showed up in the Senate after it passed, you have some wiggle room. Consider hedging on whether you would have voted for Obamacare and stress how great things might have been if only you were in the room for the negotiations.

“If I were in office in 2010, I certainly would have brought West Virginia values to it,” Natalie Tennant, a Democratic Senate candidate, told The New York Times in December when asked about the law.   

Wild card!

You could stick to the tried and true methods above, or you could try branching out into new and unexplored territory.

The most original strategy comes from Democratic Sen. Kay Hagan of North Carolina, who faces one of the toughest re-election fights in the country this year. In a recent radio ad, her campaign asserted that Republican candidate Tom Thillis thinks Obamacare is a “great idea,” thus minimizing the difference between their positions.

Well, technically he did call it a “great idea” in one sense. In another, more accurate, sense he said it was “a great idea that can’t be paid for,” and even that came in the context of a lengthy discussion of the best way to repeal the law, which his website calls “a cancer on our national economy” that “threatens the quality of every American’s health care.” 

It’s possible that kind of maneuver may be better suited for enraging your opponent’s conservative base ahead of a Republican primary than winning votes yourself. The point is, don’t be afraid to think outside the box.

Congratulations, you know have a whole menu of Obamacare options at your disposal. You can go hit the stump confident that the next time a town hall attendee or local TV reporter asks you about that health care law, you’ll already have a go-to response at the ready. Best of luck! 

The red state Democrat’s guide to Obamacare

Updated