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WASHINGTON Both parties are preparing to contest the 2018 midterm elections on a familiar battlefield health care.

Democrats see the potential for a wave that washes many of their House candidates into office, and at least some political prognosticators agree with them.

The Cook Political Report, for example, recently shifted its ratings of 20 House races in the direction of Democrats. The organizations David Wasserman based his justification for the shift on the American Health Care Act that passed the House.

For several dozen Republicans, adding support for the AHCA to their voting record is an unequivocal political risk, Wasserman wrote.

He moved southwest Iowas 3rd district from likely Republican to lean Republican. In that district, Republican Rep. David Young opposed the initial version of the legislation before eventually coming around and voting for the bill.

Cook already had Nebraskas Omaha-based 2nd District in the lean Republican category. Rep. Don Bacon, a Republican freshman, narrowly defeated Democratic incumbent Brad Ashford last year. Bacon has enthusiastically supported the health care bill.

The National Republican Congressional Committee recently named both Bacon and Young to its Patriot Program for vulnerable incumbents.

Being named to the program is a good news-bad news situation because it means the party is prepared to offer additional fundraising and organizational support, but it also means those races are among the most competitive.

Wasserman wrote that the House health care bill guarantees Democrats will have at least one major on-the-record vote to exploit in 2018 and suggested that it could help produce that wave Democrats are seeking.

Much is left to be decided on the legislation, which could change substantially as it goes through the Senate.

But both national parties have been releasing early ads that represent a kind of dress rehearsal for themes likely to fill the airwaves next fall.

Democrats cite an analysis that the legislation could increase premiums for older and sicker Americans, produce higher out-of-pocket costs and undermine protections for those with pre-existing conditions.

Republicans, on the other hand, say Democrats are simply supporting the status quo and ignoring crumbling elements of the Affordable Care Act, often referred to as Obamacare. In particular, Republicans cite the continuing trend of insurers abandoning the laws exchanges, a development that threatens to leave many Americans, including Nebraskans and Iowans, with few options.

Weve got to find a way to reduce premiums, and weve got to find a way to get more insurers back on the market so that people have choices, Bacon told The World-Herald.

Bacon has said many times that he wants to protect those with pre-existing conditions and says that the GOP proposal would still require insurers to cover those individuals. He said states that seek waivers from the requirement would have to show alternatives to protect those with pre-existing conditions. He and other Republicans have noted the billions of dollars in the legislation aimed at helping the states to cover people.

Opponents say its not nearly enough money and note that the legislation also includes tax cuts that would particularly benefit wealthier Americans.

Asked about that, Bacon said he believes in more fiscally responsible government and, while the tax cuts werent the element that sold him on the bill, he also doesnt want high taxes.

If Democrats want to campaign against tax cuts, let them go ahead and do it, I guess, Bacon said.

Enthusiasm among Democrats could result in crowded primaries next year.

In Nebraskas 2nd District, for example, Kara Eastman, who is the head of a nonprofit group known as Omaha Healthy Kids Alliance, is expected to run for the seat, while Ashford or possibly his wife, Ann is expected to be on the ballot as well.

In Nebraskas 1st District, Democrat Dennis Crawford already is running against Rep. Jeff Fortenberry, R-Neb., who supported the health care bill, and other Democrats could jump in.

Still, Drake University political science professor Dennis Goldford offered a word of caution for those on the left who see opportunity.

Democrats core supporters often fail to show up in midterm elections and its a long way to go until Election Day, Goldford said.

You can talk at this point about all the enthusiasm in the world, but we dont know yet.

joe.morton@owh.com, twitter.com/MortonOWH

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Health care looms large over 2018 midterms as Democrats see opportunity after AHCA vote - Omaha World-Herald