Subject: POLITICOs' All Policy is Local: Welcome to health care and the midterms — North Carolina Obamacare disconnect — The August recess
From: "Morning Score" <[email-masked]>
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Date: Wed, 16 Jul 2014 08:27:46 -0600

By Kyle Cheney

As a campaign influencer, you&#39;re getting this monthly newsletter as part of POLITICO&#39;s in-depth series All Policy is Local: Health Care, which provides deeper coverage of the intersection of pressing policy issues and the most-contested midterms. For more from this special reporting series, go to 
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WELCOME TO HEALTH CARE AND THE MIDTERMS - This newsletter is a monthly feature of the POLITICO series 'All Policy is Local: Health Care,' examining how health policy issues are affecting the 2014 midterm elections. Send feedback, tips and suggestions to POLITICO Pro Health Care editor Joanne Kenen at 
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FIELD REPORT - NORTH CAROLINA UNDERSCORES OBAMACARE DISCONNECT: North Carolinians rushed to enroll in Obamacare - one of the highest enrollments of any GOP-governed state - yet Democratic Sen. Kay Hagan is still getting hammered by her opponents for supporting the health law. Jennifer Haberkorn reports from Raleigh on the gap between Obamacare's impact on the ground and its perception among the electorate. "That disconnect is haunting Hagan, who doesn't go out of the way to tout her vote for Obamacare - what [her GOP opponent, Thom Tillis] calls 'Kay Hagan's Obamacare Dodge.' She often keeps her comments focused on a piece of it, the failure of state Republicans, including Tillis, to expand
 Medicaid. Her campaign website doesn't feature Obamacare, except for provisions that affect women's health, and even there she doesn't link them clearly to the president's health law." 
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THE AUGUST RECESS - Since 2010, the month-long break for lawmakers has proven a volatile, pressure-packed forum for Obamacare anxiety. With headlines now dominated by upheaval in Iraq, conflict in Israel-Gaza, crisis on the border and the simmering fight over education standards,it's unclear whether the health law will pack the same punch this summer. At a recent gathering of the nation's governors in Nashville, the health law barely came up, even when HHS Secretary Sylvia Mathews Burwell stopped in for a get-to-know-you visit with the governors. News that enrollment exceeded expectations have softened - somewhat - the urgent calls for repeal that once dominated the conversation in
 Washington.

MORE QUESTIONS FOR THE NEXT MONTH - Will Democrats find their voice on Obamacare and counter Republican horror stories with compelling successes? Do Senate Democrats in tight races become bolder about their support for the law or continue to downplay it? Will the Supreme Court's Hobby Lobby ruling trickle into the campaign talking points -on either side of the aisle? Will any more Republican-led states get to "yes" on Obamacare's Medicaid expansion?

TOP SENATE RACES

Kentucky: Senate Minority Leader Mitch McConnell is locked in a tight race with Democrat Alison Lundergan Grimes in a state that hates "Obamacare" but had one of the most positive experiences with an Obamacare-createdhealth insurance exchange. Gov. Steve Beshear, a Democrat, championed the establishment of the state's exchange, KyNect, and it worked so well he earned a shout-out in President Barack Obama's State of the Union. McConnell has to tread carefully, continuing to aggressively attack the law while remaining cognizant of Kentucky's huge coverage gains.

New Hampshire: Republican Scott Brown spent the early part of his campaign skewering Democratic Sen. Jeanne Shaheen for her support of Obamacare. But he also supported the law's template, RomneyCare, when he was a state senator in Massachusetts. Romney himself even visited the state earlier this month and hit Shaheen for her Obamacare support. Shaheen has largely embraced the law, although she's called for some fixes. She hasn't backed off even some of its more politically unpopular provisions like its employer mandate, which Brown has been using as a bludgeon.

Colorado: Sen. Mark Udall holds a narrow lead in his reelection fight against Republican Cory Gardner. Colorado went twice for President Barack Obama, and Democratic Gov. John Hickenlooper led efforts to expand Medicaid and build a state exchange. But it's one of the most pro-Obamacare states to feature a competitive Senate election that could signal whether the state's getting a little less blue. The seat was considered a safe one for Democrats, but Gardner's entrance rejuvenated Republicans there and raised hope for a GOP takeover in November.

GUBERNATORIAL RACES

Maine: Republican Gov. Paul LePage is locked in a three-way race against Democrat Mike Michaud and independent Eliot Cutler. LePage is the only New England governor to reject Obamacare's Medicaid expansion and any role in creating an exchange. In fact, he's vetoed several attempts by his state's Democratic Legislature to pass expansion legislation. Although LePage isn't particularly popular, the three-way race could divide his opposition, as it did during his 2010 victory. But if he loses, the state is likely to swing quickly toward a bigger role in Obamacare.

Arizona: Gov. Jan Brewer, a Republican, is on her way out after a bruising term that included her successful drive to expand Medicaid under Obamacare. The fight, in which she took on her state's Republican-led Legislature, left scars on all sides. It's unclear whether her successor will be as committed to the expansion (or whether it's feasible to undo, now that it's in effect). An ongoing lawsuit, filed by Republican legislators on the losing side of the expansion debate, challenges whether the plan, which included a fee on hospitals, violated the state's constitution.

Wisconsin: Gov. Scott Walker, who's among the potential GOP contenders for the presidential nomination in 2016, is in an uncomfortably tight race with Democrat Mary Burke, who hopes to unseat him and his White House aspirations before they really get underway. That's got big implications for health care because Walker rejected Obamacare's Medicaid expansion in favor of his own, state-funded plan that shifted tens of thousands of Medicaid recipients earning above the poverty level into the federal Obamacare exchange. Walker's plan also added thousands of the state's poorest residents to the Medicaid rolls, lifting a cap that had been in place due to fiscal constraints.

ON THE RADAR: In the lead-up to November, here are a few health care storylines to watch:

- The employer mandate: Liberal thinkers have started abandoning the health law's employer mandate, noting that it could be repealed or revised without much impact on Obamacare's coverage gains. Democrats, though, have been slow to take up their mantra, even as they continue to search for ways to "improve" or "repair" the law.

- Premiums coming out: The fall will feature a steady stream of premium filings for 2015 Obamacare exchange plans. They're likely to tick upward - as premiums have for years - but they're sure to provide fresh fodder for critics of the health law at a particularly sensitive moment in the campaign.

- Delays and changes: The Obama administration hasn't been shy about announcing unexpected changes and delays in key health law components, especially when they're politically tricky. Health reporters and industry officials will be watching closely for any last-minute regulatory maneuvers that could soften negative storylines ahead of November.

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