MARTINSBURG, W.Va. — Senate Democrats up for re-election in Republican-leaning states are united in opposition to the GOP health care plan.

For them, overhauling the health care system is not just about policy. It’s a matter of right and wrong.

“Someone’s got to have a moral compass inside,” West Virginia Sen. Joe Manchin III told a group gathered here for a town hall meeting last week about the Republican bill. “I made a decision on this. I said, ‘This is wrong.’”

Manchin is one of 10 Senate Democrats running for re-election in 2018 in states President Donald Trump won in November. But those Democrats are not rushing to join Republicans seeking to dismantle President Barack Obama’s signature 2010 health care law.

Instead, they say the GOP bill, known as the American Health Care Act, is a disaster. The Democrats point to a Congressional Budget Office report that showed 24 million more people would lose health care coverage by 2026 if the bill becomes law. They also warn of higher costs for seniors and adverse effects on rural communities and those fighting opioid addictions. 

Senate Minority Whip Richard J. Durbin said he was “pleasantly surprised” those Democrats in red states were so strongly opposed to the GOP plan.

That’s “because the alternative is so awful,” the Illinois Democrat said. “And I think we are in a strong position, where those who are voting for it have their hands full.”

Manchin’s Health Care Town Hall Draws Friendly Crowd in Trump State

A shift to offense

In a cycle in which Senate Democrats are playing defense — defending 25 seats in their caucus compared to nine for the Republicans — some say it’s crucial they keep talking about health care. 

“I certainly think it’s going to be tough for Republicans to explain why they’re providing windfall tax cuts to millionaires and stripping affordable care away from their constituents,” said Maryland Sen. Chris Van Hollen, the chairman of the the Democratic Senatorial Campaign Committee.

A Democratic aide working on Senate races said the issue has had an “energizing impact” on campaigns. The discussion has shifted from a theoretical conversation about repealing the 2010 law, to highlighting the GOP plan’s tangible effect on people’s lives, the aide said.

The DSCC laid out a strategy in a March 9 memo tying every GOP Senate candidate to the Republican bill. The memo highlighted the bill’s effects on seniors, women, and those combating opioid addictions.

“I think we have to get out in the community and we have to highlight the stories, the personal impact on everyday people in different parts of our states,” Van Hollen said.

Sen. Bernie Sanders, who was successful in many of those GOP-leaning states during last year’s Democratic presidential primaries, had some advice for Democrats there. He encouraged them to highlight the people who will lose health care, the tax breaks for the wealthy, and the bill’s effect on seniors. 

“I think the bottom line is that the Republicans’ so-called health care plan is not a health care plan,” the Vermont independent said. “I think Democrats have got to be very clear about that.”

Manchin sought to do that in his town hall meeting, with two West Virginians sharing their personal stories, and a representative from the advocacy group West Virginians for Affordable Health Care highlighting the bill’s impact in a PowerPoint presentation. And he committed to preserving his constituents’ coverage.

Asked if he would promise to vote against any bill that takes health care coverage away from West Virginians, Manchin, without missing a beat, said, “Yes.”

Republicans wait and see

Senate Republicans, meanwhile, are still weighing whether they can support the House plan, and aren’t making any determinations about political repercussions yet.

“I just think it’s probably too early to tell because it’s still such a work in progress,” Senate Majority Whip John Cornyn said. 

Repealing the 2010 health care law has long been a rallying cry for Republicans, helping to energize the conservative base and propelling the party to control of the White House and Congress.

Actually undoing the law, though, is proving to be difficult. GOP leaders are tweaking their current proposal to ease concerns from moderates and more conservative members. But Republicans say they are committed to fulfilling their campaign promises.

“I really think it will be a political disaster if we didn’t keep our word and do what we campaigned on,” said Mississippi Sen. Roger Wicker, a former chairman of the Senate Republican campaign operation. “Obviously, there are a lot details that have to be sorted out. But that’s the process.”

Trump went further, telling House Republicans in a closed-door meeting Tuesday morning that Republicans would lose the House in 2018, as well as some Senate races, if they do not pass the health care bill.

Trump tightrope

But in red states like West Virginia, Democrats will also have to walk a tightrope of appealing to Trump voters, while fending off criticisms from the left.

That balance boiled over at Manchin’s town hall, where more of the mainly liberal attendees advocated a single-payer, or government-funded, health care system. Manchin said he was open to exploring that option.

The few Republicans in the audience said they appreciated Manchin’s pledge to work across the aisle on health care, something his fellow moderate Democrats have also emphasized. But many senators have said they would not come to the negotiating table as long as Republicans threatened a repeal of the 2010 law.

“I’m willing to sit down. I get beat up on the left and the right,” Manchin said, prompting laughter from the crowd. “And I understand that.”

Travis Bishop, a 47-year-old Gulf War veteran from Martinsburg, said after the meeting that he appreciated Manchin’s comments about working across the aisle.

But was it enough for Bishop, a Republican and avid Trump supporter, to support Manchin’s re-election?

“That’s yet to be seen,” he said.

To hold their seats, vulnerable Democrats will need support from Trump voters like Bishop.

Democratic leaders have pointed out that the GOP plan could threaten the health care for those Trump supporters, who tend to be older or have lower incomes. So they’ve taken to referring to the bill as “Trumpcare,” a not-so-subtle message aimed at the Trump voters who may lose their health care coverage.

But some Democratic senators have said making the point that the bill could particularly affect Trump voters would not be their top priority.

“I don’t think we need to make that connection,” said Missouri Sen. Claire McCaskill, who is up for re-election in 2018 as well. “I think those Missourians will make that connection on their own.”

Lindsey McPherson contributed to this report.