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Data: Kaiser Family Foundation; Map: Harry Stevens/Axios

The number of people with pre-existing medical conditions varies substantially between metropolitan areas, according to Kaiser Family Foundation data. That means even within a single state, different locations would see different results under legislation that erodes the Affordable Care Act's protections

Why it matters: The more people who have a pre-existing condition, the more likely health care is to resonate as an issue in the midterm elections in that state or district.

  • Democrats have been making the case that Republicans threaten pre-existing conditions protections — through legislation, executive action and the courts — and have made this a dominant theme of the midterms. 
  • Some of the areas with the highest number of people with pre-existing conditions are in states with competitive Senate races, such as West Virginia, Tennessee and Indiana. 

The issue makes for absolutely brutal ads, and Democrats know it. They believe one of their most potent lines of attack against Brett Kavanaugh, President Trump's Supreme Court nominee, is arguing he could be the deciding vote against these protections. 

  • Protect Our Care has a new TV ad out today, provided to Axios, that depicts an imaginary broadcast in 2019 or 2020 announcing SCOTUS has struck down the ACA's pre-existing conditions regulations. 
  • The ad targets Sen. Susan Collins of Maine, who voted against the GOP health care bill last year. The pro-ACA group is airing radio ads tying Kavanaugh to pre-existing conditions in both Maine and Alaska. 
  • Kavanaugh's Senate hearing begins Sept. 4, the day before oral arguments in the court case that would strike down the ACA regulations.

Go deeper

Bill Clinton slams McConnell and Trump: "Their first value is power"

Former President Bill Clinton on Sunday called Senate Majority Leader Mitch McConnell's (R-Ky.) vow to fill Ruth Bader Ginsburg's vacant Supreme Court seat before the next presidential inauguration "superficially hypocritical."

The big picture: Clinton, who nominated Ginsburg to the court in 1993, declined to say whether he thinks Democrats should respond by adding more justices if they take back the Senate and the White House in November. Instead, he called on Republicans to "remember the example Abraham Lincoln set" by not confirming a justice in an election year.

Pelosi: Trump wants to "crush" ACA with Ginsburg replacement

House Speaker Nancy Pelosi said on ABC's "This Week" on Sunday that President Trump is rushing to replace the late Supreme Court Justice Ruth Bader Ginsburg because he "wants to crush the Affordable Care Act."

Why it matters: Pelosi wants to steer the conversation around the potential Ginsburg replacement to health care, which polls show is a top issue for voters, especially amid the coronavirus pandemic. The Trump administration has urged the courts to strike down the law, and with it, protections for millions with pre-existing conditions.

Mike Allen, author of AM
Updated 2 hours ago - Politics & Policy

Democrats' Armageddon option

A makeshift memorial outside the Supreme Court yesterday. Photo: Jose Luis Magana/AFP via Getty Images

Furious Democrats are considering total war — profound changes to two branches of government, and even adding stars to the flag — if Republicans jam through a Supreme Court nominee then lose control of the Senate.

On the table: Adding Supreme Court justices ... eliminating the Senate's 60-vote threshold to end filibusters ... and statehood for D.C. and Puerto Rico. "If he holds a vote in 2020, we pack the court in 2021," Rep. Joe Kennedy III (D-Mass.) tweeted.