What’s at stake

Polls show that the cost of health care is top of mind for Republicans and Democrats alike leading into midterm elections. The issue has been especially important to swing voters, making for some tight races in traditionally uncontested districts, said Patrick Murray, director of the Monmouth University Polling Institute.

"These swing voters, the issue that's really driving them is they're one health care crisis away from the rug being pulled out from under them," Murray said.

The number of people with health insurance has never been higher – 92 percent of New Jersey residents are covered – but out-of-pocket expenses for deductibles and premiums are far outpacing growth in wages and overall inflation. An analysis of employer-sponsored health plans, the most common kind of insurance for people under age 65, by the Robert Wood Johnson Foundation, found that New Jersey had some of the highest premium prices – and greatest increases in prices – in the country. Single coverage through an employer cost an average of $7,074, up 9 percent from 2016, with employees paying about a quarter of the price, plus deductibles and co-pays.

At the same time, Republicans led by President Trump have succeeded in dismantling some key parts of the Affordable Care Act enacted under the Obama administration. The tax penalty for people who don't buy insurance was reduced to zero, spelling an end to a major incentive for healthy people to stay insured. Short-term health plans, which the law limited because they don't cover some services deemed essential, like maternity and mental health (including addiction treatment), are now more accessible, a move that could leave people without needed coverage. The latest legal challenge to the law threatens to undo guaranteed coverage for people with pre-existing conditions, one of the health law's most popular provisions. In a late August phone survey of 1,201 adults by the Kaiser Family Foundation, 58 percent of Republicans and 86 percent of Democrats said it was "very important" this provision remain intact.

Key races

New Jersey's Third Congressional District: Second-term U.S. Rep. Tom MacArthur was the only New Jersey Republican to support his party's efforts last year to repeal the Affordable Care Act. He introduced an amendment that helped move repeal legislation through the House, though a companion bill was never passed by the Senate. MacArthur's amendment would have allowed states to opt out of certain parts of the law, including coverage for pre-existing conditions. Instead, it set up high-risk pools for the costliest patients, an effort that has failed in the past as the pools went broke.

Despite criticism that his health plan could leave people uninsured, health care and taxes have been top issues in MacArthur's race against Democrat Andy Kim, a Rhodes Scholar who worked under President George W. Bush and President Obama. Kim has said he was motivated to challenge MacArthur after seeing news coverage of the ACA repeal bill, and MacArthur's amendment, on a television in a hospital waiting room. Kim was there during one of his wife's many medical appointments before the birth of their second child, who doctors worried was underweight.

U.S. Senate in New Jersey: Prescription drug costs have taken a leading role in the race between a former pharmaceutical CEO, Bob Hugin, and incumbent Bob Menendez. The Democratic senator has blamed Hugin for rising costs of cancer medications made by New Jersey-based Celgene. Hugin, meanwhile, has zeroed in on nearly $1 million in campaign contributions Menendez has accepted from pharmaceutical companies.

Latest developments

Health care has dominated political campaign advertising in New Jersey, coming up in 65 percent of television ads, according to the Wesleyan Media Project, which analyzed data from Kantar Media/CMAG on ad buys for broadcast television, national network and national cable in September. In contrast, health care was mentioned in about a third of campaign ads in Pennsylvania. Nationally, about half of Democratic campaign ads and 28 percent of Republican ads have talked about health care. In September, Democrats launched a seven-figure Health Care Voter campaign, which Axios described as a "last-minute push to try to pull voters in Democrats' direction with an issue that Democrats think Republicans can't talk about on the campaign trail." The national campaign targets districts with tight races in states such as California, Florida and Maine.

Additional resources:

Other key issues in Pennsylvania and New Jersey races