When Representative Derrick Van Orden, an endangered Republican congressman in western Wisconsin, appeared recently with hospital executives, he said his goal was to root out fraud in Medicaid so that “every dollar that’s allocated” would “go to someone that needs medical care, or a hungry child.”
Rebecca Cooke, his Democratic challenger, has an entirely different health care message. Last week, she stood in front of a giant blue bus emblazoned with “Sick of It! Fix Health Care Now.” in a park overlooking a river marsh.
“I’ve talked to people here in the city of La Crosse, small-business owners who have seen their premiums go up from $400 to $1,800 a month,” Ms. Cooke said then, at an event hosted by “Protect Our Care,” a left-leaning nonprofit. “People are really, really hanging on by a thread here.”
The dueling messages in a crucial state encapsulate the different approaches to an issue high on voters’ minds in the final days of the campaign. As the 2026 midterm season barrels toward a close, the two parties are talking past each other on health care. Republicans see the big problem as fraud. Democrats say it is cost.
Polls show clear partisan differences in what voters think. A recent survey by KFF, a health policy research organization, found that Democrats were twice as likely as Republicans to say addressing health care costs was “extremely important.”
After spending much of 2026 citing the high price of gas and groceries as proof of an “affordability crisis,” it makes sense for Democrats to build their closing argument around health costs, said Celinda Lake, a Democratic strategist.
“A lot of races are finishing on it,” she said. “It’s the No. 1 cost-of-living issue where Democrats have the biggest advantage.”
Fraud in government programs is Republicans’ top issue, the KFF survey found, with more than half calling it “extremely important.” Mollyann Brodie, who oversees polling and research at KFF, said Republicans may be building messages around fraud to close the “enthusiasm gap” in what looks, for them, to be a tough year.
But Joel White, who advises Republicans on health policy, said talking about fraud will not address voters’ concerns about the cost of care.
“Very few people make the leap to say if you reduce fraud, I will pay less, this will make things more affordable,” said Joel White, who advises Republicans on health policy. “Republicans kind of hung their hat on the fraud and abuse angle and tried to make the affordability argument, and it’s kind of falling flat.”
Democrats have long had an advantage on health care. But in the past they focused primarily on access, especially as they fought to defend the Affordable Care Act, the 2010 law that created Obamacare. This year, two votes in Congress changed the health care landscape, pushing cost to the top of Democrats’ affordability agenda.
A set of enhanced Obamacare tax credits, enacted as a temporary measure during the pandemic to make premiums more affordable, expired in January after the Republican-controlled Congress refused to extend them. Premiums have shot up by 58 percent, according to an analysis by KFF, and deductibles have soared.
Ms. Cooke has her own story about that: She is one of an estimated five million Americans who gave up their insurance coverage, saying it was no longer affordable, when the Obamacare tax credits expired.
President Trump’s giant domestic spending bill, which passed last year, included $1 trillion in cuts to federal Medicaid spending over the next 10 years. Many of those cuts have not yet gone into effect, but they pose a threat to cash-starved rural hospitals and are estimated to swell the ranks of the uninsured from 30 million today to 37 million in 2036, according to the Congressional Budget Office.
The bill created a $50 million fund to shore up rural hospitals. Democrats like Ms. Cooke, a daughter of dairy farmers, say it is not nearly enough. Two hospitals closed in the district in 2024.
When Health Secretary Robert F. Kennedy Jr. turned up at a local dairy farm with Mr. Van Orden, he highlighted both the fund and the health benefits of milk. Ms. Cooke called the visit “a slap in the face to rural Americans.”
Similar debates are unfolding around the country. In Pennsylvania, Representative Scott Perry, a seven-term Republican incumbent, is in a tough race against Janelle Stelson, a former TV news anchor. During a recent debate, Ms. Stelson, a Democrat, complained that Mr. Perry “voted for a bill that is threatening struggling hospitals” and would “take health care away from people who live here and need it.”
Mr. Perry shot back that insurers need to be more transparent about prices, so that patients “can shop around” and focus on “wellness, as opposed to sick care, which is what we have now” — a remark that echoes Mr. Kennedy’s Make America Healthy Again movement. He said his vote on the domestic spending bill “actually saved Medicaid” because the real problem with health care is fraud.
“Pennsylvania is the state with the most Medicaid fraud cases of any state in the country,” Mr. Perry said.
Mike Marinella, a spokesman for the National Republican Congressional Committee, said Republicans were “laser-focused on lowering health care costs for working families.”
Some Republicans in tight races have sought to claim the health cost issue for themselves.
Representative Mariannette Miller-Meeks of Iowa, a physician and former public health official, sponsored the Lower Health Care Premiums for All Americans Act. It passed the House and died in the Senate. In Michigan, Representative Tom Barrett is backing the Great American Health Care Plan, but it is stuck in committee.
“It’s just sitting there,” complained Sarah Chamberlain, the president of the Republican Main Street Partnership, who would like to see House leaders take more interest in the issue.
More than 80 percent of voters say the economy and cost of living are their top concerns; 69 percent say health care is a top issue, according to a recent poll by The Associated Press and the NORC Center for Public Affairs Research. Voters say they are feeling the pinch from rising premiums and the high cost of drugs.
John Havlicek, a retired high school Spanish teacher and union activist who appeared with Ms. Cooke in La Crosse, gained local internet fame when he went to Washington, courtesy of the liberal Center for American Progress, and confronted Mr. Van Orden about the price of food and medicine.
Mr. Havlicek received a diagnosis of Type-2 diabetes 18 months ago, he said in an interview. When diet, exercise and a medicine to lower his blood sugar failed to improve his health, his doctor put him on a GLP-1 drug to treat the diabetes. The drug also causes weight loss. Mr. Havlicek’s health improved and he lost 30 pounds.
But then his insurance quit covering the drug, which cost $1,000 a month.
“I’m angry, I’m scared and I’m fighting,” he said.
Ms. Cooke is making her second attempt to unseat Mr. Van Orden, a retired Navy SEAL and two-term incumbent who describes himself as a “100 percent disabled veteran.” A string of federal officials — Mr. Trump, Mr. Kennedy, Vice President JD Vance, Defense Secretary Pete Hegseth and Kash Patel, the F.B.I. director — have campaigned with him.
The congressman is a die-hard Trump supporter: After the president approved a firing squad execution of the gunman who killed 13 people in Fort Hood, Texas, Mr. Van Orden made headlines with a social media post suggesting he wanted to participate.
But in a rare break with his party — and a sign of how much his constituents are concerned about the cost of care — he voted to extend the Obamacare tax credits. Mr. Van Orden said he could not “sit back and watch my constituents lose access to health care or face massive premium hikes,” though he called it a “temporary patch” for a broken health system.
Before becoming a candidate herself, Ms. Cooke ran a political consulting firm and a small shop specializing in “Made in America” goods. She also founded a nonprofit to help businesses owned by women. Republicans have painted her as a Democratic operative and tried to label her a socialist.
She calls herself a centrist. She supports expanding Medicare, but not Medicare for All, the proposed universal government-funded health program championed by Senator Bernie Sanders, independent of Vermont. Even so, Mr. Sanders has endorsed her and campaigned with her on Sunday. The Blue Dog PAC, which backs moderates, has endorsed her as well.
In 2022, after her first race, Ms. Cooke said, she sold her shop; she now works part time as a waitress. She was insured through Obamacare and the tax credits she received meant she did not have to pay anything “because I didn’t make enough income,” she said. But when the tax credits expired, her costs went up to $250 a month. She also pays $80 a month, out of pocket, for two prescriptions.
“I’m pretty healthy,” she said. “But fingers crossed.”
If she wins her election, she will have coverage again, paid for by the taxpayers, as do all members of Congress.
The post In Dueling Health Messages, Democrats Focus on Cost and Republicans on Fraud appeared first on New York Times.
