When anesthesiologist Andy Harris appeared on a cable news show last month in his white doctor's coat to discuss the health care debate in Congress, his message was about more than the pros and cons of the legislation.
Harris, a Maryland state senator who is running for a U.S. House seat, was also making a subtle political statement: The health care debate shaping up in Congress is likely to have big implications for the 2010 election.
"Health care has been pushed to the forefront," said Harris, a Republican whose race against Democratic Rep. Frank Kratovil is a tossup, according to the non-partisan Cook Political Report. "Almost regardless of what Congress does, it's going to be an issue for debate."
Fifteen months before the midterm congressional election, health care is appearing in candidate stump speeches and interviews — particularly by Republican challengers, such as Harris, running in districts recently claimed by Democrats.
That dynamic helps explain why a $1 trillion-plus health care bill stalled last week in Congress. House Speaker Nancy Pelosi, D-Calif., is negotiating with skeptics in her own party, and Senate Majority Leader Harry Reid, D-Nev., said his chamber would not meet an August deadline to vote.
On Sunday, Pelosi told CNN's State of the Union that she remains confident a bill will pass the House. But Rep. Jim Cooper, D-Tenn., said on CBS' Face the Nation that Democrats have "a long way to go" before reaching a deal.
A top Senate Democrat, meanwhile, acknowledged there isn't enough support within the party to pass health care. "There are not the votes for Democrats to do this just on our side of the aisle," Sen. Kent Conrad, D-N.D., said on ABC's This Week.
Obama has said he wants lawmakers to finish health care by the end of the year, in part because it could become mired in election-year politics. All 435 members of the House and 36 members of the Senate are up for election in 2010. "The election tends to shorten the life of the Congress," said Duke University political scientist David Rohde.
Democrats have added 24 seats in the House and nine in the Senate since last year. Kratovil, who beat Harris for the eastern Maryland congressional seat last year, is one of 52 fiscally conservative Democrats known as the Blue Dogs. The group, which has been holding up the bill, wants more savings to pay for it.
"I'm doing my best to look at neutral information," said Kratovil, who said he is concerned about the cost of the bill and that it doesn't do enough to encourage doctors to practice in rural areas.
"I'm not here to make decisions based on how I can guarantee getting back. I'm making the best decisions I can."
Yet candidates across the country are raising the issue and putting pressure on incumbents. Among the talking points: A government-run health benefits program will put private insurers out of business.
"Having the government involved in health care to that degree is really counterproductive," said Steve Chabot, a Republican running to reclaim the Ohio seat he lost to Democratic Rep. Steve Driehaus last year.
Driehaus responded with an argument Democrats are likely to use in races across the country: Complex legislation like health care requires votes that won't make everyone happy. "When the Republicans were in charge, they didn't do anything about health care reform," he said. "Now they want to suggest that all of these challenges facing us started on Jan. 20."
Former U.S. congressman Steve Pearce is a Republican who ran an unsuccessful Senate campaign last year and is now trying to reclaim his House seat. Pearce made health care part of his announcement speech this month, arguing that the House bill would raise taxes in a tough economy.
Pearce's Democratic opponent, Rep. Harry Teague, said he also has "serious concerns" about some provisions, including a proposed surtax on families earning more than $350,000 a year. That, spokeswoman Sara Schreiber said, "could have a disproportionate impact on small businesses."
Schreiber said Teague is focusing on an overhaul that makes "eliminating waste and cutting costs top priorities."