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In one of her recent TV ads, Democrat Michelle Vallejo accuses Republican U.S. Rep. Monica De La Cruz of two unforgivable political sins: jeopardizing Social Security and Medicare, and working against efforts to lower health care and prescription drug prices.

The charges are leveled by three women from De La Cruz’s 15th Congressional District, who tell viewers, “In South Texas, you keep your word. That’s why I can’t vote for Monica De La Cruz. She broke her promises to us.”

But De La Cruz hotly disputes the claims, which the ad attributes to proposals from her Republican colleagues aimed at preventing Medicare and Social Security from going broke. De La Cruz said she views the entitlements as “??vital lifelines for our seniors.”

The debate is one of several ways in which health care issues are playing an outsized role in one of Texas’ only competitive congressional races this year, even as immigration and the economy remain top of mind for many voters. Beyond Social Security and Medicare, which provide retirement benefits and health coverage to seniors, De La Cruz is also fending off attacks over her support for Texas’ abortion ban, as Vallejo and national Democrats look to seize on backlash sparked by high-profile cases of women leaving the state to receive medical care for life-threatening pregnancy complications.

Vallejo, meanwhile, is grappling with her past embrace of Medicare for All, a single-payer system that would provide universal coverage by replacing almost all current public and private health insurance plans with one government-run program. Vallejo backed the proposal when she ran for Congress in 2022, as part of a progressive platform that helped her emerge from a crowded primary, before losing to De La Cruz in November by 8.5 percentage points. For the rematch this cycle, Vallejo has dropped the issue from her lexicon, pushing more broadly for a system that “limits the power and influence of insurance companies” and allows more people to access affordable care.

Both candidates, in fact, have touted ways of expanding coverage to more residents. The district is anchored in Hidalgo County, where nearly one in three residents lack health insurance coverage — the highest rate of any major county in Texas and more than three times the national rate. The overall uninsured rate of the district — which runs through rural South Texas up to Guadalupe County east of San Antonio — is also nearly one in three.

Vallejo often refers to the struggles her mother endured when seeking care for multiple sclerosis, which she battled for 15 years before dying at age 46. Vallejo’s family could not afford care in the United States, so they would often travel to Mexico where doctors and medication are cheaper.

“No one should have to cross the border into Mexico for affordable medical care and treatment, but that’s the reality in South Texas,” Vallejo said in a statement, adding that the country’s health care system is “broken and leaves many South Texans uninsured, underinsured, and one trip to the hospital away from bankruptcy.”

Among the fixes, Vallejo said, would be for the Texas Legislature to expand Medicaid to include more low-income, uninsured Texans. Texas, the state with the largest percentage and total number of uninsured people, is one of 10 states that has not expanded coverage under the Affordable Care Act, creating a “coverage gap” for those who make too much money to qualify for Medicaid but not enough to receive subsidized coverage in the Affordable Care Act marketplace.

Texas Republicans say the program encourages government dependence and is poorly managed, making it not worth the red tape that would come with expansion. Democrats insist the opposition is rooted in the politics of opposing anything linked to former President Barack Obama.

Vallejo said she would “fight to expand Medicaid” but did not specify whether that meant passing federal legislation that would force the GOP-controlled Legislature to do so.

Vallejo also says she supports expanding Medicare to cover a wider range of medical needs, such as long-term care, hearing, and more types of dental care.

Asked about her stance on Medicare for All, Vallejo did not explicitly embrace the proposal but also appeared to leave the door open to it, saying, "I am committed to expanding quality, affordable health care for the people and families of TX-15 by any means possible."

De La Cruz said she wasn’t buying Vallejo’s moderated approach to the issue.

“Michelle Vallejo cannot hide from the fact that she stood shoulder-to-shoulder with [Vermont Sen.] Bernie Sanders in supporting a radical socialist government takeover of health care, which would devastate local hospitals and eliminate private medical care in America,” De La Cruz said. “That’s not what South Texans want.”

For her part, De La Cruz said she has sought to expand health care access by signing onto bills aimed at bolstering telehealth access for rural residents needing specialty care and eliminating wait periods for metastatic breast cancer patients to access benefits. She also opposes the Biden administration’s modest cut in base payments to insurers for Medicare Advantage plans, which are administered by private insurers backed with government funding.

De La Cruz also pointed to a bill she introduced last year, the Healthy Babies Act, that would eliminate what she called “an unnecessary rule” that prevents low-income families from using federal benefits to buy baby food that combines certain ingredients.

“By cutting red tape and making common-sense reforms, we can make sure our families and seniors have the support and care they need,” De La Cruz said of her bill, which has yet to reach the House floor.

Though none of these issues by themselves are likely to decide the election, health care has proven to be a potent political issue in past elections. In 2018, Democrats won a number of seats in Congress by hammering Republicans for trying to scrap the Affordable Care Act and arguing the GOP would imperil coverage for preexisting conditions.

A study published earlier this month by University of Texas at Austin researchers found that Latino voters around the country are driven by health care and the economy more than any other issues. Hispanic residents make up about three-quarters of the eligible voting-age population in Texas’ 15th Congressional District, according to U.S. Census Bureau data.

In a UnidosUS poll from August, health care and abortion trailed only inflation, jobs and immigration as the most important issues among Hispanic Texans. In the Rio Grande Valley, 72% of Hispanic voters said they agreed with the statement that it is “wrong to make abortion illegal,” regardless of their personal beliefs about the procedure.

Senior benefits and abortion

One of the biggest topics in the Vallejo-De La Cruz contest lately has been Vallejo’s ad attacking De La Cruz on Medicare and Social Security.

To make the case that De La Cruz is threatening the entitlements, the ad cites early 2023 reporting on House GOP proposals to fix Medicare and Social Security funding gaps — including raising the age of eligibility and offering more flexibility to use private-sector plans. Republicans said the changes would not affect current participants and were needed to ensure the programs’ continued existence, while Democrats blasted the proposals, accusing the GOP of pursuing harmful benefit cuts.

Around the same time, some Republicans also backed a plan to balance the federal budget within a decade, which Democrats and some economists argue would be all but impossible without touching the entitlement programs.

De La Cruz, weeks into her first term, did not propose any of the changes, though before joining Congress, she voiced support for allowing new workers to invest in their own privately funded retirement accounts, rather than pay into Social Security.

The measures cited in Vallejo’s ad, however, did not come up for votes in the House, and De La Cruz’s main connection appears to be her membership in the Republican Study Committee — a caucus that includes De La Cruz and about 80% of all House Republicans — whose leadership proposed many of the changes to Social Security and Medicare.

De La Cruz disputed the ad’s claims in a statement, noting that she co-sponsored a bill last year that would exempt Social Security and Medicare from the U.S. government’s statutory debt limit.

“Let me be absolutely clear: I strongly oppose cuts to Social Security and Medicare,” she said. “My radical opponent is lying about my stance on seniors’ benefits the same way she is misleading voters on her position on border security,” referring to Vallejo’s toughened posture on immigration.

Vallejo’s ad also referred to a plan earlier this year from the Republican Study Committee to remove Medicare’s ability to negotiate prescription drug costs and end a monthly cap on insulin. De La Cruz did not take a firm position on the issue when asked where she stands.

"If negotiating drug prices can reduce costs without stifling innovation or limiting access to life-saving medications, it’s worth studying," she said. "However, we must remain cautious of unintended consequences, such as reduced investment in research and development."

Andrew Smith, a political science professor at the University of Texas Rio Grande Valley, said the ad could resonate among the district’s sizable population of retirees or those close to retirement age.

“Regardless of the merits of her attack, I do think she believes that she can peel off voters that might be perhaps turned off by her previous more liberal stances on border security,” Smith said, adding that the issue will likely be overshadowed by topics like the economy yet could make just enough difference to swing a close race.

Vallejo has also focused her attacks on De La Cruz’s abortion stance, pointing to her past support for Texas’ abortion ban, which lacks exceptions for cases of rape and incest. If elected, Vallejo says she wants to “restore the rights guaranteed to women for more than 50 years under Roe v. Wade,” which protected abortion until the point when a fetus can survive outside the womb — around 22 to 24 weeks. Vallejo did not say whether she thinks the Senate filibuster should be eliminated to codify Roe.

“The decision if and when to start a family is between a woman, her doctor, and her faith, not politicians like Monica De La Cruz,” Vallejo said.

De La Cruz previously ran for Congress touting her anti-abortion views, with her campaign website’s issues page featuring a “Pro-Life” section where she vowed to “always support the sanctity of life.” Her page no longer mentions the issue, as The Daily Beast first reported earlier this year.

De La Cruz said she considers abortion “a deeply sensitive issue that demands a balanced and compassionate approach.”

“I believe this matter should be decided at the state level, and I hope that states will adopt policies that protect both innocent human life and the rights of women,” De La Cruz said in a statement. “Like President Reagan, I believe in exceptions for women facing heartbreaking circumstances, and I strongly support the right of every single American to start a beautiful family through IVF.”

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This article originally appeared in The Texas Tribune at https://www.texastribune.org/2024/10/02/texas-congress-health-care-monica-de-la-cruz-michelle-vallejo/.

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