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Data: Kaiser Family Foundation Health Tracking poll conducted April 20-30 and June 11-20 2018. Margin of error ±5%; Chart: Chris Canipe/Axios

In recent elections, Republicans have effectively used health care and anti-Affordable Care Act sentiment to rally their base. Now, the repeal effort has made the ACA more popular and given Democrats a weapon to use to motivate their base and reach out to independents.

Between the lines: The importance of health care as a national priority is sometimes overstated — but our recent polling shows it really could be a decisive issue in the midterms. That's because it has been surging as an issue for Democrats, and in an election many see as a referendum on President Trump, it may now be as important a factor as Trump is.

By the numbers: The surprising number from our tracking polls: 33% of Democrats pick health care as the top factor in their vote in the upcoming elections, while 30% pick Trump. For the general public, 25% pick health care, about the same percentage as pick Trump (26%).   

The health care surge is reflected in the public’s ranking of issues that will be important to their vote. Usually, health care ranks as one of a group of top issues behind the economy and jobs. Now, health care is the top issue for Democratic and independent voters for the midterms, and tied for second with immigration for Republican voters.

  • In fact, health care actually ranks higher now for Democrats than it did for Republicans in the anti-ACA elections of 2010 and 2014, when it ranked third on their list of issue priorities.

Health care is not one issue on the campaign trail — it’s a collection of issues. Protections for pre-existing conditions is the most important issue to voters right now, topping others like ACA repeal, drug prices, stabilizing the marketplaces, and even the possibility of the Supreme Court overturning Roe v. Wade.

But the polling shows that all the health issues currently on the agenda are breaking through, particularly with Democrats and independents. Two issues — protections for people with pre-existing conditions and drug prices — have unique bipartisan traction, which can matter in swing states and races.

It is hard to completely separate Trump from health care, since many people believe the Trump administration is working to make the ACA fail (56 percent) and nearly half feel that’s a bad thing (47%, and 77% of Democrats).

The other side: The ultimate role health care plays will depend on how effectively the issue is prosecuted in the campaign by Democrats, and how Republicans respond. And a lot can still happen between now and November to change voter priorities. A big combat operation overseas, a report from the Mueller investigation or any big unexpected development could bump health care down the hierarchy of voter concerns.

The bottom line: I have always been cautious about hyping health care as a factor in elections. But if circumstances do not change, this is an election where health care may not only be a top issue, but also a critical factor in the vote.

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