Campaigning on health care used to mean talking about coverage or costs. Now, in the run-up to the midterms, it's just as likely to focus on "corruption."

The big picture: Candidates are accusing primary or general election opponents of being in the pockets of drugmakers, insurers and other powerful health interests, to the detriment of voters.

• It's a strategy that plays into affordability concerns and voter anger at the health system — but frequently avoids addressing what about the system needs fixing.
• "Voters want leaders to lower everyday costs and firmly believe that will require taking on political corruption, corporate power and special interests' influence," public opinion firm Lake Research Partners wrote last month in a survey of attitudes about affordability and accountability.

Zoom in: That thinking is influencing the tone of one of the most competitive House races in the country, in Iowa's 1st Congressional District. GOP Rep. Mariannette Miller-Meeks and Democrat Christina Bohannan, along with their surrogates, have accused each other of caving to big health insurers and undermining patient care.

• In Michigan, Democratic Senate hopeful Abdul El-Sayed called his Republican opponent Mike Rogers a "pharma lobbyist," prompting Rogers' campaign to send a cease-and-desist letter and threaten legal action.
• Charges of coziness with health industries also are surfacing in key Senate races in New Hampshire and Nebraska.
• And some democratic socialists have played up drug and insurer donations to incumbents in primary challenges, as was the case when Melat Kiros knocked off 15-term Rep. Diana DeGette in Colorado's 1st Congressional District.

Between the lines: Polling shows medical costs are the public's top economic worry.

• Democratic challengers are trying to leverage that sentiment by focusing attention on opponents' campaign contributions, while Republicans tend to key on Democratic policies they say are handouts to certain industries.
• The Lake Research Partners survey, commissioned by the progressive PAC Indivisible Action, found voters respond to the idea that rising costs stem primarily from corporate greed, corrupt CEOs and price gouging instead of government spending and waste.
• "Voters aren't just concerned about the economy today; they are fed up with the resulting unfairness of a rigged system," it stated. "They see insiders, politicians, and corporations with too much power and elected leaders prioritizing their interests while ordinary people pay the cost."

Flashback: GOP lawmakers in Congress and outside conservative groups portrayed the Affordable Care Act as a profit-making machine for health insurers last year as they rallied to allow the expiration of pandemic-era enhanced subsidies.

• A recent NPR analysis of YouTube ads found Republican candidates are now trying to get ahead of criticism of the subsidy expiration, and of health spending cuts in last year's sweeping reconciliation bill, by focusing on fraud in Medicaid, rural hospitals and affordability.
• But Democrats think they can pin more health care cost issues on Republicans — and are highlighting policies in the reconciliation bill they say upended millions of lives and widened gaps in care.
• Some are also criticizing President Trump's drug pricing deals, saying they really delivered big pharmaceutical companies tax breaks, regulatory relief and other perks.

What's next: House Democrats have already vowed to reverse the Medicaid cuts in the reconciliation bill and restore the enhanced ACA subsidies. But there's an added oversight component some are talking up on the campaign trail.

• "We need to be doing a lot more to take on corporate power, to break up a lot of these monopolies that are rolling up — Big Pharma, insurance, private equity entering the space of health care unchecked," Rep. Alexandria Ocasio-Cortez (D-N.Y.) told NBC. "I think there's a lot here for us to really dig in on, to work on."

What we're watching: Whether Republicans take Trump's advice to go on offense by making insurance companies the enemy in the final months before the midterms.

• Democrats also will have to rely on more than partisan attacks and lay out a credible reform agenda and how they plan to take on corruption and hold special interests accountable, Lake Research Partners said.

Insiders aren't expecting Congress to address voter concerns about the health system before November — and the odds of substantive action in a lame-duck session aren't looking great, either.

Why it matters: While there's bipartisan interest in issues like hospital and insurer price transparency, lawmakers could opt to take the path of least resistance and run out the clock.

State of play: Members and senators busied themselves with hearings and bill introductions before leaving to campaign, including last week's rollout of a bipartisan House plan to cap insulin costs at $35 per month for people on private insurance.

• There's continued pressure for them to pass another "doc fix" to raise Medicare physician payments.
• But even narrow proposals could serve as starter fuel if Democrats flip one or both chambers, and especially if they achieve unified control after 2028, TD Cowen analyst Molly Turco wrote in a recent note.
• Areas ripe for action would include Medicare Advantage, pharmacy benefit managers and vertical integration in the health system, she noted.

Between the lines: Providers stand to benefit most from Democratic priorities, Capstone analysts wrote in a recent report.

• Big health systems would gain from the restoration of enhanced ACA subsidies or a rollback of Medicaid cuts in the GOP's reconciliation bill that could support hospital volumes and margins.
• Priorities that progressive candidates have campaigned on, like "Medicare for All" or capping hospital costs in concentrated markets, don't stand much of a chance in a split or fully Democratic Congress.
• That's because moderate establishment Democrats will likely hold committee chairmanships and run the agenda, the analysts wrote.