Red-state GOP candidates on the wrong side of ACA debate where voters favor fix over repeal

If Republicans are successful in this year's congressional elections, repeal is likely to be front-and-center in the next session. (Gage Skidmore/CC BY-SA 2.0)

GOP senatorial candidates are on the wrong side of the Affordable Care Act repeal debate, according to recent polling, and it could be their Achilles' heel come November. 

However, if the party is successful in this year's elections, repeal is likely to be front-and-center in the next session. 

According to an Axios/Survey Monkey poll, about half of voters in Arizona, Tennessee and Nevada want Congress to "fix" the 2010 law, while only about 30% want it "repealed." All three states currently have Republican-held Senate seats up for election this year, which could be key to deciding which party controls the Senate.

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All three races are more competitive than originally thought, and conservative candidates' position on healthcare is likely to come back and bite them, healthcare experts tell FierceHealthcare. 

RELATED: 4M lose coverage as insurance gains under ACA start to reverse

In Nevada, a historically purple state, Democratic Senate candidate Rep. Jacky Rosen has already attacked Republican incumbent Sen. Dean Heller for caving in to pressure from the White House last year and voting for various repeal efforts.

In Tennessee, Rep. Marsha Blackburn continues to tout legislation she introduced in 2015 that would repeal the ACA, while running for the seat being vacated by Sen. Bob Corker. Meanwhile, in the Grand Canyon State, Rep. Martha McSally, the front-runner for the Republican nomination, has consistently voted for repeal efforts.

"While they would need to be pro-repeal to win a GOP primary, this position will come back to haunt them in the general election," Julius Hobson, senior policy adviser at Polsinelli PC, told FierceHealthcare. Of the three candidates, only McSally is facing serious primary challengers. 

Additionally, final notices for exchange premium increases are typically released in mid- to late October. If premiums are up, it's likely to make healthcare a very prominent issue just before the election. 

However, if the GOP can hold on to the House and pick up some Senate seats, repeal efforts are likely to be rejuvenated next year. In its budget proposal released earlier this year, the Centers for Medicare & Medicaid Services (CMS) said it plans to "wind down" the ACA exchanges by 2020, but only if Congress can pass a full repeal. 

During various repeal-and-replace efforts last year, the biggest roadblock to success was the Senate, where the GOP currently holds a narrow majority. If the party boosts their number of seats from 51 to 53 or 54, repeal through reconciliation is much more likely than it was in 2017. 

"If Republicans keep to their repeal-and-replace stance, and win, they would take that as the public supporting their position," Chris Dawe, a former White House and National Economic Council healthcare policy adviser under the Obama administration, told FierceHealthcare. Dawe currently serves as a senior vice president at Evolent Health. 

RELATED: Tom Price pulls a 180 on individual mandate, says GOP's repeal will increase premiums

Many have predicted that the combination of the individual mandate repeal and CMS' planned expansion of short-term health plans will likely lead to a drop in coverage and increased premiums, giving a hypothetical GOP-controlled Congress more reason to retry a repeal. 

However, Dawe added that the president might not be interested in taking up that political fight again and could be satisfied with repeal of the mandate alone.

"My gut is that Trump feels like he already repealed this, and he's moving on to other things," he said. 

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