WASHINGTON -- Democrats and Republicans agree on one thing about the hotly contested Affordable Care Act: When it comes to voter intensity, the GOP holds a clear upper hand.
But a trio of major liberal groups hopes to change that in coming months, with plans to spend tens of millions of dollars persuading residents in a dozen key states to vote for Democrats based on the issue. Whether the groups succeed could help determine not just control of the Senate but the fate of key governor's races and the law's viability.
The Service Employees International Union, Planned Parenthood Action Fund and MoveOn.org have each launched campaigns in recent weeks aimed at mobilizing support for both the law itself and those officials who back it. By focusing on more popular parts of the law -- including Medicaid expansion, free birth control coverage and a bar on denying coverage for pre-existing conditions -- the groups hope to coax individuals who often skip voting in midterm elections to make it to the polls.
The advocacy groups say they are still honing specific plans but that the pieces are already in place. Tens of thousands of volunteers and campaign workers are already engaged, having spent the past few months dedicated to signing people up for insurance plans under state and federal health insurance exchanges.
The organizations now plan to apply that same machinery to the midterms, with a particular focus in states that did not expand Medicaid but have competitive gubernatorial or Senate races, such as Louisiana and Florida. They are shifting over thousands of workers and volunteers who had been focused on enrollment to become steeped in Medicaid expansion. And they plan to return to the people they enrolled in coverage and ask them now to vote.
The groups say they are devoting significant resources to the efforts. Planned Parenthood Action Fund will spend between $12 million and $15 million, according to its president, Cecile Richards. MoveOn's PAC and other arms "will spend millions" on issue advocacy and direct support of candidates, according to executive director Anna Galland.
SEIU Healthcare executive vice president Kirk Adams, whose division has more than 1.2 million members, said the Medicaid expansion issue resonates with many voters who often sit out nonpresidential election years. Polls show majorities of voters support enlarging the program with the help of federal funds, even in some deep red states.
"We have an issue we think can motivate folks, and we feel like we have a pretty clear defining line between Candidate X and Candidate Y," Mr. Adams said.
But they face stiff odds, in part because Democratic turnout tends to drop off significantly during midterms. And among the general electorate, GOP voters who oppose the Affordable Care Act, also known as Obamacare, are the most fired up.
A recent national Quinnipiac poll found that half of Democrats said they were more likely to vote for a candidate who supported the law, while 8 in 10 GOP voters were less likely to vote for such a candidate.
"A turnout message that half of your base doesn't care about is not very compelling," Brad Dayspring, spokesman for the National Republican Senatorial Committee, wrote in an email. "That is a 26-point intensity gap between the parties."
The law also remains unpopular with voters overall and has yet to provide a significant boost to Democrats even after the administration exceeded its enrollment goals.
"The real issue is whether they can make it more intense for Democrats," said Robert Blendon, a health policy and political analysis professor at Harvard University. "In off-year elections, it's intensity -- not public opinion -- that matters."
Liberal groups say the fact that 24 governors and state legislatures have declined the law's optional expansion of Medicaid -- even though the federal government would initially cover all the costs -- could prove decisive in gubernatorial races in Florida, Georgia, Kansas, Michigan, Pennsylvania and Texas.
A handful of those states also have competitive Senate races, and some Democrats have already seized on the issue. During a confirmation hearing this week for the new Health and Human Services chief, Sen. Kay Hagan, D-N.C., used her time to criticize her state's Republican leaders for keeping roughly 500,000 residents off Medicaid's rolls.
"These are some of the most vulnerable in our society, who will continue to seek care in emergency rooms and then will leave chronic conditions unmanaged, which we know is detrimental to their health and the economy," said Ms. Hagan, who is being challenged by state House Speaker Thom Tillis, a Republican.
SEIU and two other progressive groups sent out an email Friday to supporters suggesting that a 32-year-old mother of three in Florida died because she did not qualify for Medicaid coverage.
In addition to pushing Medicaid, the organizations are also trying to convince voters they could lose other benefits under the law.