By Yasmeen Abutaleb and Jason Lange
BEREA, Kentucky (Reuters) - Andy Barr, a Republican lawmaker representing central Kentucky, won his last three elections promising to repeal and replace Obamacare. This year, his Democratic challengers for Congress in Kentucky's sixth district are betting that message will ring hollow.
Their hopes lie with voters like Joyell Anderson, who went for President Donald Trump in 2016 and said she generally votes Republican. This year, she is not sure who to support for Congress, but she knows what her top priority is: healthcare.
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The 43-year-old stay-at-home mother, who suffers from diabetes, anxiety and depression, is one of more than 400,000 low-income Kentucky residents who obtained Medicaid coverage under President Barack Obama's 2010 Affordable Care Act. Barr's vote last year to repeal Obamacare scared Anderson.
In 2016, she said, her top concerns were jobs and the economy, having grown up in a family of coal miners. Now, she worries about losing Medicaid and about work requirements introduced by the state's Republican governor.
Politicians "need to think about us ordinary people," she said, speaking at the rural health clinic that provides her care. "(We could) lose our benefits. And then what's going to happen?"
Kentucky's sixth congressional district, where two well-funded Democrats are running in a May primary to see who will stand against Barr in November, has in recent years gone solidly Republican. Barr won 61 percent of the vote in 2016.
Republicans say they are confident that Barr's support will remain solid this year. "Both Democratic candidates are currently too busy fighting each other over who’s the biggest progressive — a surefire way to lose in a district where voters don’t subscribe to their liberal brand of politics," said Jesse Hunt, spokesperson for the National Republican Congressional Committee.
But many analysts see enthusiasm for the party weakening in the district and have identified it as one of several dozen seats Democrats might be able to pick up in the House of Representatives.
Democrats believe that voter concerns over rising medical costs and Republican plans to cut Medicare and Medicaid will assist them in their fight to retake the House and are urging candidates to emphasize the issue, particularly in swing districts.
Republican strategists are encouraging their candidates to focus more on the economy in November's election. When they do talk about healthcare, many Republican candidates, including Barr, are warning voters that a Democratic majority would usher in socialized medicine.
Graphic: Voters say healthcare top concern, click https://tmsnrt.rs/2qaqXor
PROTECTORS OF HEALTHCARE
Residents of Kentucky's sixth district, home to both the city of Lexington and to rural towns struggling with the loss of coal jobs, have reason to focus on healthcare. People there suffer from lung disease at rates that far outstrip those in the rest of the country and drug overdose rates in parts of the district are among the highest in the nation.
Obamacare has deeply affected the area, mostly due to Medicaid's expansion. After the health law took effect, the share of district residents with health insurance rose by 8.1 percentage points, nearly twice the national average, according to a Reuters analysis of Census Bureau data.
"Obamacare is a good thing," said Jerry Harris, 66, who likes the job Trump is doing but describes himself as a Democrat. He relied on an Obamacare exchange plan before he was eligible for Medicare and has a daughter on Medicaid.
"I want to hear candidates talking about bringing down costs," he said.
Democratic candidates nationwide are being encouraged by the party to cast themselves as protectors of healthcare. Last month, House Minority Leader Nancy Pelosi urged congressional Democrats headed home for the spring recess to focus on "Republicans' relentless efforts to dismantle the health care of seniors and families across America."
Barr's main Democratic challengers feature healthcare as a top concern on their campaign websites. One of them, Lexington Mayor Jim Gray, says his number one issue is protecting and fixing healthcare.
"We cannot go back to a time when the insurance companies called the shots and denied coverage for pre-existing conditions," he writes.
The Democrats' other top contender, former Marine fighter pilot and mother of three, Amy McGrath, says Barr has failed to deliver meaningful healthcare reform. For years, she says, Republicans promised to repeal Obamacare and replace it with something better.
"That's the reason I'm running; I'm tired of the lies," she said in an interview.
Barr's campaign website focuses on themes Republicans are emphasizing this year: cutting government spending, balancing the federal budget and creating jobs. His "vision" section does not mention healthcare.
His most important message this year, he says, is economic. “When the people that I represent sent me to Washington, they wanted me to focus on growing the economy,” Barr said in an interview. “We’ve done that in a dramatic way.”
On healthcare, Barr said he believes voters are still angry over rising health insurance costs under Obamacare and that his message that the program has failed still resonates.
Barr also warns voters that, with Democrats in control, “bureaucrats in Washington D.C. will be in charge of your personal healthcare.”
Graphic: Insurance coverage has surged in some congressional districts, click http://tmsnrt.rs/2FbSfEB
‘LENS OF THEIR OWN LIVES’
Since Trump took office more than a year ago, Americans increasingly cite healthcare as the nation’s biggest problem, ahead of the economy, immigration and crime. A March Reuters/Ipsos survey of more than 12,000 adults found that healthcare was the top concern of more respondents than any other issue.
Recent Reuters/Ipsos polling and data analysis has also found that healthcare concerns of older, white, educated voters could tip the scales toward Democrats in tight congressional races.
More than two dozen Republicans and Democrats interviewed in Kentucky’s sixth said they were dissatisfied with current policies, but their ideas for reform did not necessarily dovetail with their parties’ platforms.
Former horse trainer Mary Bennett, 45, for example, said she voted for Trump but has not decided whether she will vote at all in November. Like many Republicans, she says Congress should get rid of Obamacare. But her ideal solution is one embraced by the most liberal of Democrats: Put everyone on Medicare.
Both Democratic and Republican strategists acknowledge that views on healthcare are complicated.
“I don’t think people generally look at healthcare and regurgitate the Republican view or Democratic view,” said Matt Mackowiak, a Republican consultant. “They look at it through the lens of their own lives.”
(Additional reporting by Chris Kahn; Editing by Michele Gershberg and Sue Horton)