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Since President Trump took officejust under two years ago, the Affordable Care Act (ACA) has beenthe center of debate and, more often, confusion. Though theproposed repeals andmodifications to the Americanhealth care system have died down in recent months, health care isstill a hot-button issue in this year's midtermelections.

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Here's a look at where the ACAstands leading up to midterm elections, and how the polarizingissue is affecting both Republican and Democratcandidates.

Republicans: The push for further repeal

Even though theRepublican-controlled Congress failed to completely repeal the ACAin 2017, the GOP hasn't given up. Many Republican candidates, ledby President Trump, are continuing to push for an ACA repeal,including protections for people with pre-existing conditions, andare highlighting rising premiums as proof of the ACA'sfailure.

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Related: 'Nothing is safe.' How the ACA is impactingattorney general races

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Meanwhile, some moderateRepublicans are distancing themselves from the party line.In North Dakota'sSenate race, Rep.Kevin Cramer committed toensuring protection for people with pre-existing conditions,despite previously voting for legislation that would weaken theACA. Republican Senator Susan Collins (ME) is alsoopposed to the party's push toremove these protections, consistent with her voting recordagainst GOP repeal bills.

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In the 29 swing districtswith elections this November,Republicans running for re-election will likely be pressed on theissue, and forced to acknowledge their party's push for totalrepeal. With more than 20 millionAmericans at risk of losing healthcarecoverage, it's no wondersome candidates are trying to distance themselvesfrom the ACA on the campaigntrail.

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If the special election resultsare any indication, Republicans could struggle to maintain controlof Congress come November. Earlier this year, Democrat Conor Lambbeat out Republican candidate Rick Saccone in a special election inthe state's deeply conservative 18th CongressionalDistrict, a districtTrump won by 20 points in 2016. And this month, GOP candidate TroyBalderson narrowly won in a tight race with Democratic candidate Danny O'Connor inOhio's 12th Congressional District special election, a state thatPresident Trump won by 11 points two years ago.

Democrats: The hope for status quo

Democratic candidates, meanwhile,are campaigning on the ACA's success — namely how it has grantedmillions of Americans access to health care — and on the generalpublic's desire for Congressto give up on health care reform and focus on other initiatives. Additionally, inseveral congressional races, Democrats are criticizingRepublican-leading states like Florida, Georgia, North Carolina,South Carolina, Texas and Wisconsin for not adopting the Medicaidexpansion of the ACA.

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Democratic candidates are alsohighlighting President Trump's failure to fulfill his promise toeliminate the ACA completely and replace it with a new, lessexpensive plan. They're taking a different approach fromRepublicans on rising premiums and blaming it on the repeal of theindividual mandate in 2017. Since then, ACA premiums haveincreased 34 percent, andthey're predicted to increase by another 3.6 percent in 2019. Democrats maintain rising costs areundermining the efficacy of the ACA and ultimately making it harderfor Americans to afford health insurance.

The verdict:Health care is on the hot seat

Health care has never beenseamless, but the spiraling ACA debate is the focal point for bothparties in the midterm elections. Republicans continue arguing theACA was repealed and will have to answer to the millions ofAmericans at risk of losing coverage, and Democrats keepchampioning the remaining requirements of the ACA to protect thoseAmericans' access to health care.

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Related: Republicans botch Obamacarepolitics

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In order for Democrats to takeback the House in November, they'll need to reclaim 23 Republicanseats. With 29 districts deemed competitive between the parties,control of the House is definitely up for grabs at the midtermelections. Should Democrats win control of the House, any billsaimed at dismantling the ACA will be taken off the table. IfRepublicans maintain their majority, it wouldn't be surprising tosee them launch another ACA repeal effort.

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There are also six Senate seatsup for grabs from Republicans. If Democrats gain two of these seats(and defend their existing seats) they will have the Senatemajority, and the likelihood of a successful ACA repeal attemptwill decrease significantly.

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With the future of both theSenate and the House in murky waters, the heated health caredebates from state to state hold a lot of power in the future ofthe ACA, and for the millions of Americans on the border of losingtheir coverage this fall.

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Arthur Tacchinois principal and the chief innovation officerat SyncStream Solutions, a reporting and compliancecompany with solutions for everything from health care reform toEEO-1.  He  presents frequently to the NationalAssociation of Insurance and Financial Advisors (NAIFA), theNational Association of Health Underwriters (NAHU), the FinancialPlanning Association (FPA), and otherorganizations.

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