By completely ignoring healthcare as a midterm issue, Republicans risk losing crucial votes

Despite knowing the harm his Obamacare repeal bill could unleash on those who voted for him and his past insistence that he would never cut Medicaid, Trump attempted to push through the legislation as soon as he took office

In the run-up to America’s crucial midterm elections next Tuesday, President Trump and his Republican colleagues have focussed on immigration as the central issue in the campaign’s final days. In rallies, TV interviews and, of course, tweets, Trump has hammered this message, relentlessly stoking fear in the hearts of voters.

A caravan of migrants making its way to the US border has somehow become the campaign’s biggest issue – a testament to Trump’s sinister ability to distract and bend narratives. He has also revealed plans to end birthright citizenship — the right enshrined in the US constitution that guarantees citizenship to any child born in America, regardless of whether their parents are citizens.

Trump fanning the flames of racial division is nothing new, particularly relating to America’s border with Mexico. We all remember the chants of “build the wall” at his 2016 campaign rallies.

Yet behind the poisonous Trumpian rhetoric directed towards minorities and the so far non-existent wall, the president’s most discernible, real-world 2016 election campaign pledge — to improve the US healthcare system — is mysteriously absent from his midterm manifesto.

Following the Republicans’ midterm election campaigns, you’d be hard pressed to find any mention of healthcare. Trump himself has not sent one tweet about healthcare in the last three months. In the same time period, 51 of his tweets mention the words “wall”, “border” or “immigration”.

But voters should be mindful of what the Trump administration might do to their health rights if Republicans are successful in the midterm elections. Attempting to repeal the Affordable Care Act, introduced by President Obama and dubbed “Obamacare”, was the first thing Trump tried and failed to do as president in 2017.

Republican House Speaker Paul Ryan had eight years to draft a better healthcare plan than Obamacare, after spending the former president’s entire term blocking, complaining and criticising the legislation. Yet the bill that the Republican leadership proposed in 2017 was widely criticised, even by Republicans.

The plan would have seen millions of Americans, particularly in Trump-voting states and districts, paying substantially more for healthcare. It drastically cut Medicaid — the US program for low-income children, adults, seniors and disabled people that was expanded in 31 states under Obamacare — which now covers around one in five Americans.

Approximately 41 per cent of Medicaid enrollees are white, but the proportion of white recipients in key Trump-voting swing states is much higher: 67 per cent in Ohio, 59 per cent in Michigan, and 58 per cent in Pennsylvania. Combined with new restrictions on pre-existing conditions, these cuts could have left 24 million more people uninsured.

Yet, despite knowing the harm this bill could unleash on those who voted for him and his past insistence that he would “never” cut Medicaid, Trump still attempted to push through the legislation.

The border state of Texas, where Republican senator Ted Cruz is locked in a tight race with Democratic challenger Beto O’Rourke, has a higher proportion of uninsured people than any other US state. In a state where a staggering 17.3 per cent of people are uninsured, on the border with Mexico, it makes sense that Cruz would invite his former rival Trump to campaign alongside him and focus on immigration instead. Cruz, who supported the unsuccessful GOP healthcare bill in 2017, also backed Trump’s calls to end birthright citizenship, saying it “incentivises” illegal immigration.

It is no coincidence that the three traditionally “red” Republican-run states also have the highest percentage of uninsured people – Texas, Oklahoma and Alaska. And the three states with the lowest percentage uninsured people — Massachusetts, Hawaii and the District of Columbia – are run by Democrats. This trend presents a huge opportunity for Democrats such as O’Rourke, who have made expanding healthcare access, Medicaid and lowering costs a central message of their campaigns.

O’Rourke may not be able to flip Texas blue, a state that has had Republican leadership for almost 50 years. But the fact that Republicans are not making any bold health-related promises is a grim sign of what could be on the horizon if they make gains in these crucial elections. Behind the noise on immigration, Republicans are quiet on healthcare. For those who currently depend on Obamacare and Medicaid, this silence could be deadly.