Why A Bitter Health Care Fight Is At The Center Of A High-stakes House Battle

ALBANY, New York — One of the most-watched House races in the country is setting the stage for how Democrats and Republicans will battle over federal health care cuts on the campaign trail.

Swing seat GOP Rep. Mike Lawler, facing a tough reelection campaign against a moderate Democratic opponent, is being bombarded by attacks over his vote for President Donald Trump’s sweeping domestic policy package, which cut Medicaid spending by nearly $1 trillion over a decade.

The pressure is only expected to intensify.

His general election foe Cait Conley, the Democratic Congressional Campaign Committee and a constellation of allied super PACs are ready to hammer Lawler over the issue as he runs for a third term in the highly competitive suburban New York House district.

The House Democrats’ campaign arm plans to blast Lawler over the expected fallout from the spending changes, including millions of people losing insurance coverage, health care job cuts and the loss of local hospital funding. Battleground New York, a labor-aligned super PAC whose backers include the health care union 1199SEIU, accused Lawler of having “ripped health care away from thousands of families in his one district to bankroll another round of tax cuts for the wealthy.”

Despite these headwinds, the Republican lawmaker is going on offense — contending state-level Democrats did nothing to prevent thousands of New Yorkers from losing their health care coverage and touting his own efforts to blunt the impact of cuts on the state.

“I’m not going to shy away from my record, or what we did in the bill to fortify the system and to root out waste, fraud, and abuse to make sure we have protections for those who rely on [Medicaid],” Lawler told POLITICO. “New York has made certain decisions — they spent 80 percent more than the average state on Medicaid. That’s a policy choice of the state, and they have to take some level of responsibility for the overall cost of their program and how they go about spending these dollars.”

The issue is especially sensitive in Lawler’s Hudson Valley district, where roughly 14,000 residents lost access to New York’s Essential Plan on July 1 after the federal government narrowed eligibility to the low-cost public health plan. The region is also home to nine hospitals that each receive more than 40 percent of their revenue from Medicaid and Medicare, according to the Health Care Association of New York State.

How Lawler parries these attacks will set the tone, and potentially lay out a playbook, for Republicans across the country on health care costs — an issue where his party has traditionally struggled with voters. Lawler’s race is among a handful in the country that are expected to determine which party controls the narrowly divided House and the fate of Trump’s final two years in office.

The incumbent’s allies believe that Lawler — a seasoned, often combative former political operative who unseated a prominent Democrat four years ago — is well positioned to withstand the broadsides over health care.

“I always will place my bets on Mike Lawler to be able to effectively get his message out,” said GOP state Assemblymember Matt Slater, a Lawler ally. “If anybody in the party can buttress the attacks that are coming especially related to health care, I certainly think Mike Lawler is that guy. We’re expecting a barrage, but Mike Lawler is the one who is going to be able to counteract the negative campaigning that we’re expecting.”

Democrats are yet to commit a specific spending target for the issue, but there’s no doubt it will be a key piece of their efforts to target voters over affordability concerns. More than 70 percent of Americans are very concerned about health care costs — higher than for any other area — according to a Pew Research Center poll conducted earlier this year. Conley’s campaign plans to make the issue a key component of her campaign to unseat Lawler.

“Mike Lawler voted with Donald Trump for the largest gutting of Medicaid in history and to restrict Medicare's ability to negotiate lower prescription prices, and now hundreds of thousands of New Yorkers are getting kicked off their health care while monthly premiums are skyrocketing,” she said in a statement. “The Hudson Valley is sick of career political operatives and lobbyists like Lawler getting rich working for their party bosses and drug and insurance industry donors, while families get stuck with higher costs."

Conley’s message is getting boosted by left-leaning health care advocacy groups seeking to unseat Lawler due to his vote on the sweeping tax-and-spend law, which Trump dubbed the “One Big Beautiful Bill Act.”

Maddie Twomey, communications director for Protect Our Care, said the national health care advocacy group is watching Lawler’s race very closely with the expectation that it stands to be a barometer for voter sentiment over funding cuts.

“This election is about cutting $1 trillion from our health care and who is going to fight to restore these cuts, to give people their health care back to make it cheaper,” Twomey said. “Democrats are extremely aligned on that issue. Republicans already voted to take it away. They showed their hand here; they showed that they're more interested in siding with billionaires and big corporations over the health care for working families.”

Health care has been an Achilles' heel for Republicans in close races, and Democrats in the past have effectively wielded the issue as a cudgel amid the decadelong efforts to roll back Obamacare provisions. Their push to repeal the landmark health care law during the first Trump administration sparked massive blowback and helped Democrats flip 41 seats and win the House in 2018.

Democrats are hoping to use that same playbook to similar success in this year’s midterm elections.

“We're seeing a trend of Republicans trying to deflect from their vote for this bill, but they can't hide from the reality that health care costs have skyrocketed for millions of families, that entire hospital systems are grappling with Medicaid cuts, and people are already losing access to essential services in certain states just because of the Medicaid cuts on the horizon,” Twomey said.

Lawler has more than $4.3 million in cash on hand to counter these claims. Conley, who emerged from a crowded and sharp-elbowed Democratic primary last month, reported $940,973 cash on hand at the end of June.

The incumbent also has a deft, aggressive communication style to turn back attacks on his health care record. There is yet to be any independent polling in the district, but the seat, which former Vice President Kamala Harris won by 1 point over Trump, is at the forefront of both parties' congressional designs.

Lawler has made headway with the Trump administration to insulate New York from some of the most immediate federal funding cuts, including helping to secure a nine-month extension to the state’s lucrative health plan tax, which is expected to generate roughly $1 billion in additional funding. He also advocated for the release of long-delayed FEMA reimbursements tied to the COVID pandemic, and advocated for Hochul’s request to revert the Essential Plan to the Basic Health Program, which preserved low-cost coverage for 1.3 million New Yorkers.

“I've been very direct and upfront with my constituents about what we did and why, and will continue to be and will continue to lead on these issues,” Lawler said. “If New York is not going to do anything to fundamentally start to address the systemic problems within the health care system in New York, then the situation is going to continue to worsen, and to me this is recognizing not the politics of it, but the actual substance of it.”

Trump, who endorsed Lawler last year, appeared alongside the incumbent House lawmaker at a May rally in his district. The president praised the Republican’s advocacy for a provision in the domestic spending package that raised the cap on state and local tax deductions (known as SALT) from $10,000 to $40,000. The change was considered crucial for suburban swing seat lawmakers in blue states like Lawler, whose voters pay some of the highest property taxes in the country.

“He didn’t stop,” Trump said of Lawler’s push to raise the cap. “This guy was a pain in the ass.”

Republicans believe the SALT victory will help offset the attacks over health care.

“The fact he was able to go up against a president of his own party and hold out until he got that is phenomenal,” said former Westchester County Executive Rob Astorino, who Lawler previously served as a political adviser.

Blaming the Democratic-dominated state government, including Gov. Kathy Hochul, is also expected to be a key factor in Lawler’s counteroffensive.

Hochul has repeatedly pointed fingers at Lawler and his Republican colleagues when asked about the state’s response to federal policy changes that resulted in health care coverage losses for roughly 450,000 New Yorkers earlier this month. Members of her own party, however, have blamed Hochul for blocking proposals by the Democratic-led Legislature to create resources for the individuals losing access to the state’s Essential Plan, plans Hochul’s administration said would cost too much to implement.

“Congressman Lawler and his Republican colleagues voted to strip away healthcare from New Yorkers,” Hochul spokesperson Jonah Allon said in a statement to POLITICO. “While we have repeatedly warned that no state can fully backfill these draconian cuts from the federal government, we are committed to supporting New Yorkers who have lost health coverage.”

Allon noted that the state is providing guidance for the individuals left searching for health care coverage on the state’s health insurance marketplace.

Yet Lawler allies maintain the state holds responsibility for failing to shore up the insurance coverage — a lack of action by Democratic officials that voters will be aware of by November.

“New York state deserves some of the responsibility for where we are right now,” Conservative Party Chair Jerry Kassar said. “New York state just loves to act like they're responsible for all those good and never responsible for all that’s bad.”