The failedGOP repeal attempt gave Democrats a chance to promote popularaspects of the law — including its ban on jacking up rates forpatients with pre-existing medical conditions. (Photo:Shutterstock)

Andy Kim decided to run against House Republican Tom MacArthurlast year as he watched TV coverage of GOP efforts to repeal Obamacare while waiting in a hospitalroom for news on his unborn son.

Kim was sparked by MacArthur's amendment that would have letinsurers charge more for patients with pre-existing conditions and his central role inhelping the repeal pass the House. An ultrasound had just shownthat Kim's son was dramatically underweight, and he wondered “if mybaby boy is going to have a problem for the rest of his life.”

“What I promised myself and my family that day was I was goingto do everything I humanly can to hold Tom MacArthur for what hejust did,” said Kim, a Democrat who's challenging the New JerseyRepublican in the November election.

Related: Another year of rolling backObamacare

The attempt to repeal Obamacare ultimately failed after getting stalled in theSenate. But the effort to scuttle the 2010 law inspired dozens ofDemocrats like Kim who have put the Affordable Care Act at thecenter of their campaigns and are using personal experiences toillustrate how a repeal would have hurt them.

Election losses

The decision by Democrats to take the offensive on health caremarks a switch in tactics from 2010, when the party lost 64 seatsand the House majority after passing the Affordable Care Act. Toclimb back they need to gain a net 23 seats to win back Housecontrol and the power to block key elements of President DonaldTrump's agenda and any further attempts to roll back the law.

House Democrats named Kim, a former Obama administrationnational security aide, to their “Red to Blue” program for top tiercandidates in Republican-held districts. His campaign reportedraising $1.1 million through March 31. The nonpartisan CookPolitical Report shifted its rating of the race between MacArthurand Kim on Friday from “likely Republican” to “lean Republican,”slightly less in MacArthur's favor.

The failed GOP repeal attempt gave Democrats a chance to promotepopular aspects of the law — including its ban on jacking up ratesfor patients with pre-existing medical conditions. After years ofattacks by Republicans, Obamacare gained majority public approvalin a Gallup poll for the first time in April 2017. A Gallup polllast month found that the cost and availability of health care isAmericans' top issue for the fifth year in a row.

MacArthur's amendment would have let states seek waivers to letinsurers charge higher premiums for those with existing conditionsand drop some benefits designated as “essential” under Obamacare,including maternity care.

Chris Russell, a campaign strategist for MacArthur, said hisamendment “sought to make coverage of pre-existing conditionssacrosanct for all Americans and ensure essential health benefitsremained the federal standard.” It wouldn't allow denial ofcoverage for a pre-existing condition, Russell said in astatement.

Higher premiums

But critics said it would have made premiums too expensive forpeople with health problems.

“I know exactly what happens when people lose their access tohealth care or health insurance,” said Kim Schrier, a pediatricianand one of five Democrats running to replace Republican DaveReichert, who is retiring from his House district in centralWashington state.

“I have my own pre-existing condition — type 1 diabetes,”Schrier said. “If I didn't have insurance through my company, Iwould be in that same situation.”

While repeated GOP efforts to repeal Obamacare have failed,Congress did vote in December to end a key component starting in2019 — the requirement that almost all Americans obtain insuranceor pay a penalty.

Premiums for 2019 are expected to be announced in October, justbefore voters head to the polls. The nonpartisan CongressionalBudget Office forecasts a 10 percent increase for people who buyinsurance on the individual market.

The individual market makes up just 7 percent of how Americansgot their health care in 2016, compared to 49 percent of Americanswith employer-sponsored coverage and 35 percent with Medicare orMedicaid. But the Affordable Care Act still drives the politics ofhealth care. Bipartisan Plan Fails

A bipartisan Senate proposal to stabilize the Obamacaremarketplace, sponsored by Republican Lamar Alexander of Tennesseeand Democrat Patty Murray of Washington, failed in March overlanguage restricting abortion funding.

Representative Ryan Costello, a Pennsylvania Republican whobacked the Alexander-Murray plan and opposed the 2017 Obamacarerepeal, said he believes voters will pay more attention to whatRepublicans are doing now.

“It's going to be much more on what are you doing, or how do youpropose to lower costs, not how did you vote on a bill that neverbecame law,” said Costello, who isn't seeking re-election.

But Democrats plan to make the argument to voters thatRepublicans should be held responsible for insurance costs becausethey control both chambers of Congress and the White House.

'Incredible contrast'

John Lapp, a Democratic strategist and former executive directorof the Democratic Congressional Campaign Committee, said, “There'san incredible contrast with Republicans, who either their answer isto take away your health care, or do nothing and allow thehealth-care market to skyrocket.”

Priorities USA, a Democratic super-political action committee,cautioned party members in a memo last month not to lose track ofthe key issues that animate voters: the economy and healthcare.

While Trump's policies are “raising the cost of health care anddriving up insurance premiums,” he gained ground on how the publicviewed his handling of health care: from a 30-percentage-point netunfavorable rating to 12-point net unfavorable, said the memoprepared by the Hart Research Group and Global Strategy Group.

Medicare for All

National Republicans say Democrats are still responsible forhealth-care costs because they enacted Obamacare.

“Democrats are responsible for Obamacare and they've donenothing as it's destroyed our health care system,” said Jesse Hunt,a spokesman for the National Republican Congressional Committee,the House GOP campaign organization. “Their only answer now movingforward is to try to push a government-controlled, single-payerhealth care system that'll total $32 trillion.”

Such proposals have gained traction among Democrats. The Houseversion of Senator Bernie Sanders's legislation to create a“Medicare for all” national health-care system has 122 Democraticco-sponsors. Liberal groups like the Progressive Change CampaignCommittee, Democracy for America and Justice Democrats haveendorsed more than three dozen Democrats running on nationalized,universal health care in Republican-held districts.

But the biggest shift for the party may be Democrats'willingness to defend Obamacare in competitive, Republican-helddistricts. Illinois GOP Representative Randy Hultgren's Democraticopponent, Lauren Underwood, is a nurse and former Department ofHealth and Human Services official who helped implement thehealth-care law during the Obama administration. Underwood beat sixDemocratic opponents in the state's March 20 primary.

“While the Affordable Care Act is not perfect — I don't thinkanybody is asserting that it is — American families have seen thebenefits of having coverage options that are affordable,” Underwoodsaid. “It touches everybody and they don't want to see it goaway.”