WASHINGTON — After years of absorbing attacks over the Affordable Care Act, its rocky roll-out and early flaws, Democrats are on the offensive.
With Republicans now holding the White House and Congress, and President Trump taking steps to undercut the law, Democrats are pounding GOP incumbents over the results, particularly in the Philadelphia area.
A potent example came earlier last week, when Pennsylvania and New Jersey regulators approved steep rate increases in the states' insurance markets for individuals, a response, officials and insurers both said, to Trump's decision to end roughly $7 billion in federal payments intended to hold down costs.
Attacks rained down on local Republicans, as campaign promises to destroy the law turned into real-world actions.
"In the Trump Administration and House Republicans' never-ending quest to repeal and sabotage the ACA, they are hurting Pennsylvania families," said a release from Chrissy Houlahan, a Democrat challenging Rep. Ryan Costello, a Republican from Chester County.
In a neighboring district centered on Delaware County, Democratic hopefuls piled on the Republican incumbent, Rep. Pat Meehan.
"@RepMeehan is silent again as Trump destroys healthcare," tweeted one challenger, Molly Sheehan. Meehan "is no leader and he is no fighter for the families of the 7th district," said a release from another, Dan Muroff.
State Sen. Daylin Leach tweeted a link to a news story about the Pennsylvania rate hike with the comment, "So much winning …"
National Democrats also dropped blanket statements assailing GOP Reps. Brian Fitzpatrick of Bucks County, Tom MacArthur from South Jersey, and Lloyd Smucker, whose Lancaster-based district includes a piece of Chester County.
Some of those targeted Republicans, including Costello, Fitzpatrick, and Smucker, have backed bipartisan plans to continue the payments. But they'll face a challenge in trying to distinguish themselves from an agenda pushed by Trump and GOP leaders.
"Republicans are going to probably see what Democrats saw in 2010, which is when you have complete control of the government, you own it. You own what happens," said J.J. Balaban, a Democratic media consultant based in Philadelphia.
He said the shift on health care is just one symptom of a "sea change" from the congressional races when Barack Obama was president. Since 2010 Republicans have fueled their campaigns by blaming Obama and fellow Democrats for rising insurance prices and diminishing choices.
Prices are now set to rise on Republicans' watch.
Rep. Charlie Dent (R., Pa.) lamented to the Allentown Morning Call, "We the Republican Party will own this."
The projected increase comes even after health-policy experts such as Larry Levitt, of the nonpartisan Kaiser Family Foundation, said the oft-maligned markets were stabilizing.
In Pennsylvania, an average increase was expected to be around 7.6 percent but leapt to 30.6 percent after Trump's move, state insurance regulators said. New Jersey's largest insurer, Horizon Blue Cross Blue Shield of New Jersey, planned an average 24.3 percent rate increase on individual ACA plans, and said the amount would have been smaller if not for Trump's change.
While many consumers will be shielded from the direct effects — tax subsidies should rise to help offset the price spikes — the headlines bolstered the Democratic charge that GOP repeal plans will hurt average consumers.
The "cost-sharing reduction" payments Trump scrapped compensate insurers for holding down the amounts low-income consumers pay for health copays and deductibles.
The payments helped 225,475 Pennsylvanians save an average of $948 per beneficiary last year. In New Jersey, 144,449 got the benefit, saving $1,150 on average for people buying coverage on the ACA's health exchanges, according to federal data analyzed by the liberal Center on Budget and Policy Priorities.
Trump, however, labeled them an illegal bailout for insurers, noting that they were never authorized by Congress and were challenged in court. Democrats counter that they were designed as part of the law, and don't increase insurer profits.
"This debate is yet more evidence that Obamacare is fundamentally broken: it's a house of cards that relies upon billions of dollars in illegal payments not appropriated by Congress," Meehan said in a statement from his office. "We need real, meaningful health-care reform that lowers premiums for families and ensures access to needed care."
Some Republicans, including Chester County's Costello, criticized Trump's decision.
He called the payments "essential" for low- and middle-income consumers until the GOP can enact reform, and backed a bipartisan Senate plan to continue them for at least two years with congressional approval. In July he also supported a bipartisan House plan that called for continuing the payments, and he has continued promoting that proposal.
He accused Democrats of creating "an alternative reality" about his views.
"I'm the only one in my race talking about actual solutions," Costello said in response to Houlahan's attacks. "So I'm not terribly worried what her consultants tell her to say."
Charlie Gerow, a Republican strategist based in Harrisburg, said Democrats won't be able to shed their ownership of health-care problems after so many years being associated with Obamacare.
"Once impressions are formed, it takes a lot of time and money to change," he said. "And there hasn't been enough passage of time to change the correct impression that most voters have had that Obamacare didn't work for them."
Democrats, however, have embraced the law — and are betting that many voters have too.