Vice President Mike Pence was the clear celebrity draw at a Nov. 20 campaign event for Georgia's two incumbent U.S. senators, Kelly Loeffler and David Perdue. Both Republicans are fighting to keep their seats against two Democratic challengers in the runoff election set for Jan. 5.
People were so eager to see Pence at the rally in Canton, Georgia, that parking spots were scarce and a long line of cars snaked through the parking lot of a community college. Some drivers jumped the curb and parked in the grass.
Hundreds of people, many unmasked, were given temperature checks before boarding large coach buses for a short ride to the rally site. The venue was a large, open space outside the conference center, but few attendees maintained physical distance
The runoff in Georgia was triggered when no candidate in either Senate race won more than 50% of the vote in the general election on Nov. 3.
In the midst of the coronavirus pandemic and with the fate of the Affordable Care Act in question, Republicans hope the two incumbents will win reelection, thus preserving their party's 50-48 control of the Senate.
But if the two challengers, Raphael Warnock and Jon Ossoff, win their runoffs, Democrats will gain narrow control of the Senate, with Vice President-elect Kamala Harris serving as the designated tie-breaker.
Yana De Moraes came to the rally from another Atlanta suburb, Buford. She is uninsured and, after a recent hospital stay, said the high cost of medical care was weighing on her mind.
"We would like our health care costs lowered, so it could be more affordable," she said, with a rueful laugh. "So you don't get another heart attack while you're getting a bill!"
De Moraes added she'd also like to see better price controls on prescription drugs to stop pharmaceutical companies from "robbing American people."
Others on their way to the rally said they were looking for any kind of change, ideally one that minimizes government involvement in health care.
Barry Brown made the 40-mile drive from his home in Atlanta for the rally. He's retired but too young to qualify for Medicare, so he has ACA insurance, which he affords with the help of a federal subsidy.
"It sort of works. It's better than nothing," Brown said. "I would like to see an improved health care situation. I don't know what that will be, so maybe they'll mention that today. I'm hoping so."
But at the rally, Loeffler only briefly mentioned her health care plan, which focuses on reducing drug prices and giving people access to insurance options that cost less but offer fewer benefits.
When it was his turn to speak, Perdue didn't talk much about health care either, though he did take a shot at Obamacare, which he's voted multiple times to overturn.
"Remember a little thing called the Affordable Care Act? You think that was done bipartisan?" Perdue asked the crowd. "No! It was done with a supermajority! Can you imagine what they're gonna do if they get control of the Senate?"
As the two Republicans have campaigned throughout the state, they have consistently stoked fears about what Democrats will do, and health care policy has not led their messaging.
Their Democratic challengers, however, have been all over health care in their own speeches.
Warnock opened his runoff campaign to unseat Loeffler with a modestly attended Nov. 12 event devoted to health care. That's also been a focus for Ossoff in his bid to win Perdue's seat.
"This is why these Senate runoffs are so vital," Ossoff explained at a small, physically distanced event in the shadow of the Georgia Capitol building in Atlanta on Nov. 10.
Ossoff and Warnock support adding a public insurance option to the Affordable Care Act. They also have emphasized the role Democrats will play in resurrecting key parts of the law if the U.S. Supreme Court decides to overturn it. The justices are set to make a ruling next year.
"If the Supreme Court strikes down the Affordable Care Act, it will be up to Congress to decide how to legislate such that preexisting conditions remain covered," Ossoff said.
Voters like Janel Green, a Democrat, connect with that message. She's from the nearby suburb of Decatur and is fighting breast cancer — for the second time. Green wondered whether her private health insurance might try to deny her coverage if the protections in the ACA disappear.
"I have to worry about whether or not next year in open enrollment that I won't be discriminated against, that I won't have limits that would then potentially end my life," she said.
More than one-quarter of Georgians have preexisting conditions that could make it hard to get coverage if the ACA is struck down, according to an analysis by KFF. (KHN is an editorially independent program of KFF.)
That possibility also drove Atlanta resident Herschel Jones to support the runoff. On a recent weekday morning, he dropped by an Ossoff campaign office to pick up a yard sign.
Jones, who has diabetes, is insured through the Veterans Health Administration. He said everyone deserves access to health care.
"It's a main issue, because the Affordable Care Act benefits all those individuals who might have preexisting conditions," Jones said.
One likely reason Ossoff and Warnock are running so much harder on health care than Perdue and Loeffler is because that strategy paid off for Democrats in the general election, said Ken Thorpe, a health policy professor at Emory University.
President-elect Joe Biden can thank independent voters for his win in Georgia, Thorpe said, and they were drawn to him because of his promise to uphold Obamacare.
"The threat of potentially losing health insurance in the midst of this pandemic turned out to be probably the major defining issue in the election," Thorpe said.
Polling in the days leading up to the Nov. 3 election showed Democrats were motivated on the issues of health care and the coronavirus pandemic.
For Democrats to win Georgia's Senate seats, Thorpe said, they'll need to stay focused on those issues. That emphasis could help them attract additional moderate voters, as well as entice those in the party base to cast ballots a second time.
"The health care issue is the probably main motivating factor that's gonna get Democrats and independents to the polls," he said.
Still, no Democrat has ever won a statewide runoff race in Georgia. That means that even with a strong health care message, it'll be tough for Ossoff and Warnock to break that trend and unseat the Republicans, Thorpe said.
This story is from a reporting partnership that includes WABE, NPR and KHN.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.