This cycle, even Democrats running in red states are unapologetically putting health care at the center of their campaign messages. There is a reason: Republican efforts to overhaul the health care system last year were deeply unpopular.

A lawsuit brought by several states imperils the health law’s protections for people with pre-existing health conditions, the law’s most popular provision. Recent polls show growing numbers of Americans rank health care as a top issue and coverage for pre-existing conditions as an important policy.

A recent analysis from the Wesleyan Media Project showed that health care was the most common subject of televised campaign advertisements by Democrats in both the House and the Senate. “This is the uniform issue across a lot of the states, and then these candidates will talk about things that are particular to their constituents,” said Lauren Passalacqua, the communications director for the Democratic Senatorial Campaign Committee.

Some ads focus on a personal connection to the issue, like the health history of a candidate or a candidate’s relative. Some focus on an opponent’s role in the lawsuit. Many House campaigns are using health care as part of attack ads against Republican incumbents who voted last year for the American Health Care Act, which would have unwound major parts of the Affordable Care Act. Some ads talk about the Affordable Care Act directly, but many gesture at it more obliquely, with talk of pre-existing conditions alone.

Health care still comes up in some Republican ads. But unlike in past cycles, when ads promising to “repeal and replace” Obamacare were standard fare, health care has been pushed down the priority list, behind taxes and immigration. (The health care law figures in only 1 percent of Republican ads, according to the Wesleyan count.) Here are what some of the new Democratic health care ads are saying and what they are leaving unsaid:

The Democratic candidate: Sen. Joe Manchin is running for re-election in West Virginia, a state President Donald Trump won by more than 41 points.

The ad: Reprising a 2010 special election ad in which he shot a hole in a cap-and-trade climate bill and promised to “repeal the bad parts of Obamacare,” he now shoots a hole in a lawsuit that could eliminate the protections for pre-existing conditions that are part of the health care law. His opponent, the state’s attorney general, Patrick Morrisey, is a party to the lawsuit. “That’s just dead wrong and that ain’t going to happen,” Manchin says, before firing.

The strategy: In 2010, Manchin’s pro-West Virginia iconoclasm meant standing up to his party’s leadership. Now, it means protecting a core provision of the health care law. The words “Affordable Care Act” do not appear in the ad — neither does Obamacare. But the Manchin campaign has bet big that health care politics in the state have changed. Instead of vowing to repeal part of the health care law, he is promising to protect its most popular provision. In fact, West Virginia has benefited more than nearly every other state from the health care law, and it is the state with the largest share of residents with pre-existing health conditions, according to estimates from the Kaiser Family Foundation.

The Democratic candidate: Clarke Tucker, a state legislator and lawyer, is running against French Hill, a two-term incumbent in Arkansas’ 2nd Congressional District. Tucker was treated for bladder cancer last year.

The ad: Tucker takes viewers on a brief tour of important places in his life, with stops at the baseball field, the church where he was baptized, his Little Rock high school, a farm where he grew up, the state House, and the cancer hospital where he was treated. He describes himself as “one of the million Arkansans with a pre-existing condition.”

The strategy: Even in a strictly biographical ad, Tucker gestures at health policy. When he got sick, Arkansas political observers thought his career would stall. Now, he presents his pre-existing health condition as a qualification for office.

The Democratic candidate: Sen. Heidi Heitkamp is running for re-election in North Dakota, in what is expected to be a tough race against Kevin Cramer, the state’s three-term congressman.

The ad: A constituent, Denise Sandvick, chops vegetables in her kitchen as Heitkamp’s voice explains how both the constituent and the candidate have pre-existing conditions. Then Sandvick speaks to the camera, expressing her disappointment that Cramer voted for the Republican health bill last year. “I know Heidi would never do that,” she says.

The strategy: Heitkamp highlights her own history of breast cancer and establishes empathy with a constituent with a similar history. Like Manchin, Heitkamp declines to mention the Affordable Care Act directly, describing Cramer’s vote simply as a choice to overturn protections for pre-existing conditions. The truth is a bit more complicated. The bill, which did not become law, could have substantially weakened pre-existing protections, but only in states that chose to do so. The bill would have also made major cuts to Medicaid and to subsidies that help middle-income Americans buy health insurance.

The Democratic candidate: Elissa Slotkin, a former intelligence analyst who worked for the CIA and the Defense Department, is running to unseat the incumbent, Mike Bishop, in Michigan’s 8th District.

The ad: Slotkin describes her mother’s breast cancer, a later loss of a job and of health insurance, and then her ovarian cancer, in the years before the Affordable Care Act became law. “It could be about anyone’s mom,” Slotkin said, while criticizing Bishop’s vote for a bill last year that would have unwound large parts of the health care law.

The strategy: Slotkin has said Republican efforts to overturn the health care law inspired her to run for office and her ad, which includes footage of her ailing mother delivering a toast at Slotkin’s wedding, is focused on the personal stakes of the policy debate. She is one of several Democratic candidates using family stories about illness and insurance coverage to explain their commitment to consumer protections.

The Democratic candidate: Sen. Claire McCaskill of Missouri is running for re-election against Josh Hawley, the state’s attorney general, in a state Trump won by more than 18 points.

The ad: “Two years ago I beat breast cancer,” McCaskill says, talking directly into the camera. “Like thousands of other women in Missouri, I don’t talk about it much.” She links her own pre-existing condition to the current anti-Obamacare lawsuit, where Hawley is a litigant.

The strategy: As a senator, McCaskill has tended to focus on consumer protections in health care. This summer, she began asking constituents at campaign events to stand up if they had pre-existing conditions. And her campaign has begun a series of 30 video interviews with supporters who have pre-existing conditions.) She tries to link Hawley’s support for the lawsuit to industry — the “insurance companies” — rather than ideology. Like many other Democrats in Republican territory, she is not pledging broad support for the health care law, but focusing on its most popular provision.

The Democratic candidate: Sen. Joe Donnelly is running for re-election in Indiana, another state Trump won handily. His opponent, Mike Braun, is the CEO of a distribution company and a former state legislator.

The ad: Donnelly shuffles papers around in a copy shop, as he praises the work ethic of his constituents and his own work on their behalf. A voice-over notes his support for Trump’s proposed border wall and for “protecting health care for Hoosiers with pre-existing conditions.” Then, a worker in the shop tells him his “break’s over.”

The strategy: As with Manchin, Donnelly’s overall strategy has been to appear pragmatic and nonpartisan, distant from Democratic leadership. On the issue of the wall, he’s in Trump’s corner. But on health care, he highlights his vote against Republican attempts to repeal and replace the health care law last year. The contrast reveals how he thinks the issues are likely to play in a red state.

The Democratic candidate: Jacky Rosen, a congresswoman representing Nevada’s 3rd District, is running to unseat Dean Heller, one of the most vulnerable Republican senators this cycle.

The ad: Rosen walks amid retractable dividers defining an empty, snaking line, leading to an unmanned reception desk. She notes that Heller initially promised to oppose a Senate bill to overhaul the health care law, while ultimately voting for its final version. Her description is interspersed with footage of Trump joking with Heller and news footage describing his change of heart. “Dean Heller got back in line,” she says.

“I’ll work to fix Obamacare, and I won’t walk the party line,” she says, opening up the divider tape and heading for the exit.

The strategy: Rosen is unusual in stating her support for Obamacare specifically, though she says that she wants to “fix” it, not preserve the status quo. Heller’s various positions on the Republican repeal effort, which he initially warned would harm the state, are the focus of this ad, and another, in which Rosen’s campaign compares him to an inflatable tube man, bending in the wind.

The Democratic candidate: Kim Schrier, a pediatrician, is running for an open seat in Washington’s 8th District. The seat is held by Dave Reichert, who is retiring. Her opponent, Dino Rossi, is a former state senator.

The ad: Footage of Schrier shaking hands in a diner, talking to people around a table and examining a child while wearing a white coat and stethoscope is interspersed with black-and-white clips of Republicans voting on the American Health Care Act. “When D.C. politicians voted to gut health care for people with pre-existing conditions, I decided to run for Congress myself,” she says.

The strategy: Schrier is one of the candidates who say they were motivated to run by the recent GOP attempts to overhaul health care. Her ad presents her as an outsider — a doctor, not a “D.C. politician.” She pledges not to accept corporate political action committee donations so she can be free to stand up to health industries. Her message is less about fixing health care than protecting current programs. But she still never mentions Obamacare.

This article originally appeared in The New York Times.

Margot Sanger-Katz © 2018 The New York Times