Health Care Vote a Pre-Existing Condition for Illinois GOP Congressman

Roskam's attempts to repeal the ACA while refusing to hold town halls with constituents hasn't sat well with a number of conservative and independent voters in the 6th Congressional District

Susan Kaye Quinn joined the Republican Party in her early 20s for its conservative economic policies and said she was a dedicated member over the next three decades. She voted straight-ticket Republican, campaigning for candidates in her home state of Illinois and attending party events around her congressional district in the suburbs north and west of Chicago.

"I was a part of the party until they nominated Donald Trump," said Quinn, a 53-year-old novelist and former environmental engineer, in a phone interview. "But I didn't leave the Republican Party, the party left me."

Appalled by Trump's rhetoric and many of his policies, Quinn crossed party lines in 2016 to vote for the Democratic candidates for president and Congress, she said. Hillary Clinton carried Illinois' 6th Congressional District by seven points even as the Republican House incumbent, U.S. Rep. Peter Roskam, was easily reelected to a sixth term.

"The Republicans threw out their principles," Quinn said. "They overlooked moral issues, Russia meddling in our elections. They overlooked all of that to gain power in Trump’s popularity."

This article, part 4 in a series, examines one of the key battleground races for control of the House of Representatives in the Nov. 6 midterm elections. Carried by grassroots momentum, Democrats must take 23 seats from Republicans to win the balance of power. They are contending with Republicans' experience and organization, and an outspoken but polarizing president.

Democrats looking to regain control of the House are hoping to separate socially progressive, economically conservative Republican voters in the 6th District from a Republican Party that moved further to the right on positions of abortion, immigration and LGBTQ rights, among other issues. Two issues they have seized on are health care and opposition to Trump's tax bill.

Republicans in districts that went for Clinton have been forced to thread a line between appealing to moderates fed up with Trump while maintaining support among the president's base. 

"It's a tough year for Republicans in suburban Illinois, we know it, but Congressman Roskam has stood up to the President on issues, especially trade and is unique in his style and not a cookie cutter Republican," said Kirk Dillard, a former DuPage County Republican chairman and veteran of Illinois politics, in an emailed statement to NBC. "Peter Roskam is on sound footing with his base."

Roskam touts himself as a moderate who opposes Trump's trade war, has advocated for a universal background checks system and elimination of bump stocks. Despite voting repeatedly to repeal the Affordable Care Act, Roskam said he supports protections for pre-existing conditions and has proposed expanding access to pre-tax health savings accounts to help pay for deductibles. The 57-year-old from Wheaton is also staunchly anti-abortion and supports legislation banning the use of federal dollars from going to organizations that provide abortion services.

"Those are the things that I'm voting on and I think those are the things that represent voters of the 6th District," Roskam told NBC. "And the proof of that is I've consistently won these elections with these views."

But Roskam's attempts to repeal the ACA while refusing to hold town halls with constituents hasn't sat well with a number of conservative and independent voters in the district. And neither did the $1.5 trillion Republican tax bill Roskam helped write, which will hurt some in high-tax states like Illinois by capping their state and local tax deductions.

"How do you respond when your representative doesn't hold a town hall to avoid hearing criticism and makes no bones about the fact the he has increased our tax burden?" Ken Hillman, a father of three from Cary, told NBC in a phone interview.

Others disenchanted with the congressman they once supported are evangelicals — voters Roskam has historically relied on — who feel that many Republican policies are contrary to Christian values.

Kristin Sterling, a 52-year-old bookkeeper at a Presbyterian church in DuPage County, told NBC she had voted for Roskam because their mothers were involved in a church women's group together and she believed "he was very religious and Christian. But the idea that we are all about ourselves, would strip health care from the poor and sick, and don't care about neighbors and the community, really bothered me."

The Democrat hoping to capitalize on Roskam's newfound weakness is Sean Casten, a clean-energy entrepreneur and political newcomer from Downers Grove. Casten emerged from a crowded field to defeat initial frontrunner Kelly Mazeski, a breast cancer survivor, in the primary.

Casten has made protecting and expanding health care access under the Affordable Care Act a top priority of his campaign. He says he's "unapologetically" pro-choice and supports legislation that will protect young immigrants living under former President Barack Obama's now-threatened Deferred Action for Childhood Arrivals (DACA) program.

Casten has also vowed to work on restoring state and local tax deductions and proposes investments in infrastructure and clean energy as a way to boost the middle class economy.

That appeal seems to be working. Earlier this month, the nonpartisan Cook Political Report shifted its rating for the district from tossup to leaning Democratic.

"Democrats didn't get their ideal nominee here back in March, but in this kind of political environment, it may not matter," said Cook's David Wasserman in his ratings analysis of the race. "Roskam, who hasn't had a competitive race since beating now-Sen. Tammy Duckworth for this seat in 2006, is now trailing Casten in both parties' polling."

Red, Blue and Green
The 6th District is predominantly white, highly educated and affluent. More than 50 percent of residents have college degrees and the median household income is just shy of $100,000, according to the Census. That's potentially bad news for Roskam in the current environment — a March poll from Pew Research Center found a larger share of college graduates favor Democrats.

Roskam's seat has been solidly Republican since the mid-1970s, reinforced in 2011 when the Democratic-controlled state legislature redrew the district to pack in Republicans and maximize Democrats' hold on surrounding districts. But despite the gerrymandering, the C-shaped district that arcs through Chicago suburbs in five counties has voted for presidents of both parties in recent years: Obama in 2008, Mitt Romney in 2012 and Clinton in 2016.

"When Hillary won in 2016 we realized there are more of us here than we think, and there are fewer hard-right Republicans in this district than we assumed," said Leslie Sadowski, a liberal who moved to Downers Grove in 2012. "In the past, I think most people took for granted that it was a red district and stayed home."

Peter Cooper, a lawyer from DuPage County, said he's never been involved in Democratic politics and voted Republican in the 2016 primary, but did not support Trump.

"I was so appalled by the tenor and tone of President-elect Trump that I began looking for opportunities to get involved," he said.

Cooper joined political activism groups, encouraged friends to consider runs for public office and has volunteered for Casten's campaign.

And Cooper is not alone. More than 67,000 residents voted in this year's crowded Democratic primary, up from just 8,615 in the 2014 midterm primary.

Roskam, who ran unopposed both years, received 56,544 votes this year. The Republican's vote total was down by nearly 9,000 from four years earlier.

Dillard warned not to discount Roskam's support among a "tried and true conservative" base, which includes evangelicals, and told NBC he believes they will be loyal to the congressman "even if some want to break with Republicans."

Both candidates have seen millions of dollars pour in from their parties and outside groups.

Roskam spent about $800,000 more than Casten and had nearly $500,000 more on hand through the end of September, according to their Federal Election Commission filings. More than $1 million has been spent by outside groups to attack Casten or back Roskam, compared to less than $200,000 to support Casten or oppose Roskam.

Roskam's Pre-Existing Condition: Voting Record
Wasserman noted Roskam's vulnerability stems from his party-line votes. According to the political analysis website FiveThirtyEight, the congressman has voted in line with Trump's position 94.6 percent of the time.

"I don't see why we'd fire our representative to get back at the president," Brad Hagstrom, a Roskam supporter from Downers Grove, told NBC. "I believe Peter is an American first and a Republican second."

In a September debate with Casten, Roskam stood by his congressional record, arguing that many of the votes included in the FiveThirtyEight statistics were for "common-sense" legislation like hurricane and opioid relief, support for veterans, funding for government agencies and sanctions on Russia, Iran and North Korea. Roskam called Casten's claim that he's aligned with the White House an "over-characterization" and said he's condemned Trump both privately and publicly on issues like trade tariffs and funding cuts to the Great Lakes clean-up and preservation program. 

But it was Roskam's repeated votes to repeal and replace the Obama-era Affordable Care Act, most recently by backing the GOP's American Health Care Act last summer, that voters who spoke to NBC found "reprehensible." The bill, a priority for the Trump administration, passed the House but was narrowly voted down in the Senate.

For months before the vote, Roskam had refused to hold town hall meetings with constituents who were concerned about losing pre-existing condition protections they had under the Affordable Care Act. Citing the "drama" at those types of events, he instead conducted tele-town halls, "which are much more civil," he told NBC.

Few of the constituents who spoke to NBC have been satisfied with the "don't call me, we'll call you" format, which selects callers and prescreens questions, and Roskam has been hounded by protesters demanding a public meeting.

Roskam told NBC that the ACA is a "catastrophic failure" because of rising premiums and limited providers in the exchange for some areas of the country.

However, experts argue that a major factor behind rising premiums and the reduction of health care options was uncertainty over the law's future caused by frequent attempts by the Republican party to kill or weaken it. The average price of premiums for benchmark plans will actually go down by about 1.5 percent in 2019, the Centers for Medicare & Medicaid Services announced this month. That's because insurers who increased the price of 2018 premiums in reaction to the failed Republican repeal bill are now rolling back prices to correct for overinflation.

Roskam said he is advocating for a replacement health care plan that will increase competition, lower premiums and include protections for pre-existing conditions. But with the individual mandate repealed under the tax bill, many of the constituents who spoke to NBC said they question the feasibility of attaining a comparable level of coverage to the ACA without either increasing cost or cutting services.

"Insurance as a business model is made up of a risk pool. You need healthy people to balance the cost of the unhealthy ones," said Cooper, the DuPage lawyer. "I think it's disingenuous to suggest that we are going to reduce premiums but increase benefits, but we need to find better and more efficient ways to provide health care."

Cooper said he believes in access to health care for all and is skeptical of Roskam's "lip service" to pre-existing conditions without offering specifics on an overall plan.

Casten's platform calls for building on "Obamacare," as the Affordable Care Act is often called, and moving the country toward universal health care by creating a public option for people to buy into the Medicare system.

"What we should be doing from a data perspective is recognize that as a country we spend more per capita on health care than any other country in the world and have worse outcomes than every other country that has universal health care. And the ACA was not universal health care but it was closer than what we had before," Casten said in a phone interview.

Cutting the SALT on Taxes
Like many Republican members of Congress in Democratic-leaning states across the country, Roskam faces the challenge of defending the $10,000 limit on state and local tax (SALT) deductions that were part of the Republicans' Tax Cuts and Jobs Acts of 2017.

In a high-tax state like Illinois, where more than 43 percent of returns claim SALT, property and sales taxes, many voters in the 6th District may be particularly hard hit by the cap on their SALT deductions, according to the Tax Policy Center.

Roskam, who is the chairman of the Tax Policy Subcommittee for the powerful House Ways and Means Committee, said the original version of the GOP bill had a zero-deduction allowance and that he insisted on the $10,000 break, calling it a "sweet spot" for his district. He maintains that middle-class families will see a net benefit due to changes in other parts of the tax law.

But constituents who aren't seeing a big bump in their paychecks are skeptical.

"My property taxes alone is over the $10,000 cap, so the SALT limit will definitely hurt my family this year," said Carolynne Funk, a mother of four from Lake Zurich, who plans to vote for Casten.

Proponents of the SALT cap, like Hagstrom and Deborah Kraus of Hillsdale, defend the decision. Kraus said that while she may pay more in taxes, limiting the deduction puts pressure on the "Illinois machine" to reduce taxes and tighten its spending belt.

For Crystal Lake resident Greg Alexander, his biggest concern is the long-term impact of the $1.5 trillion tax cut on the federal deficit budget. The Congressional Budget Office estimated that it will add $1.9 trillion to the national debt by 2028, and could be higher if provisions of the tax cut that are set to expire are renewed instead.

"Eventually the deficit will need to be paid down, and they are going to do that by cutting Social Security, Medicare and other safety nets," Alexander said. "It's just horrible."

Asked about concerns over the deficit, Roskam told NBC that said while he understands the criticism, the money borrowed to pay for tax cuts will keep companies and jobs in Illinois and the U.S. "The question is do you take on debt to buy something that is increasing in value and the answer is 'yes,'" he added.

Casten has vowed to restore SALT deductions and said he supports lifting the payroll cap, currently $128,400, on earnings subject to the Social Security tax in order to fund entitlement programs long-term. He said he also supports raising the gas tax, which was last increased in 1993, to pay for road and other infrastructure projects.

"These are the things that are going to help the economy and the middle class," Casten said. "Not huge tax cuts skewed to the very wealthy."

More Than Just 'Pro-Birth'
Jeff Greenberg, a historically single-issue voter from Wheaton told NBC he is abandoning the anti-abortion ticket this year to vote for Casten, a shift for a district that was previously represented by Henry Hyde, the namesake of the Hyde Amendment restricting federal funding for abortion.

Greenberg, a "pro-life evangelical Christian" who teaches geology and environmental science at Wheaton College, the alma mater of Rev. Billy Graham, said that while he disagrees with Casten on the issue of abortion, he feels his proposals for health care, taxes and for tackling climate change are more aligned with his Christian values than those of Roskam.

Greenberg said he had always voted a pro-life ticket, supporting Roskam in at least two elections. But with Roskam defending Trump's Muslim ban, repeatedly voting to repeal the ACA, failing to protect "Dreamers" and supporting a tax bill that "further widens the income inequality gap," Greenberg said he's realized that anti-abortion advocacy can't be the only thing he looks for in a candidate.

"To be a pro-life, you got to be more than just pro-birth," Greenberg said.

Roskam did not respond directly to the "pro-birth" criticism but he told NBC he's "not going to be defensive about being pro-life" and condemned Casten for not supporting the Pain-Capable Unborn Child Act — restricting abortions at 20 weeks — and favoring expanding the availability of taxpayer-funded abortions.

Casten maintained that abortion should be a decision between a woman and her doctor and not the government. He told NBC he believes the only way to actually reduce incidents of abortion is by decreasing the chances of unplanned pregnancy through access to contraception, maternity health services and sex-education. Those are all positions that Greenberg said he supports.

Casten is also capitalizing on a growing contingent of voters who support women's reproductive rights and are frustrated over the Republicans' resolve to defund organizations that provide preventative care like Planned Parenthood.

"As a college student and a young professional, I relied on Planned Parenthood for affordable birth control," said 49-year-old Erin Micklo of Glen Ellyn. "This administration's determination to destroy both affordable contraception for those who cannot afford it and their desire to make medical and reproductive decisions for women is abhorrent and terrifying."

Micklo has voted for Roskam four times, including 2016, she said. But the high school teacher said she is the parent of a gay daughter and a son with a disability and is actively working to flip the 6th in the midterms in order to protect the rights of LGBTQ Americans and pre-existing conditions afforded under the ACA so that her son will always have access to healthcare.

"In some ways, at nearly 50 years old, I feel more alive and energized than I've ever felt in my life," Micklo added.

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