Health care was the top issue referenced in campaign advertisements ahead of the US Senate primaries in Arizona and Florida on Tuesday, driven largely by Democratic messaging.
The focus on health care illustrates the Democrats strategy to largely avoid messaging around President Donald Trump's scandals in Washington and instead drive home issues they believe resonate more with voters.
In Arizona's Republican Senate primary, the candidates' efforts to tie themselves to Trump were on full display in TV ads.
Immigration and security have also colored ads in the Arizona race, and entitlements, taxes, and term limits have been points of emphasis in Florida.
Over $42 million worth of TV advertising has blanketed the airwaves in the two states through the week of August 28.
A CNN analysis of Kantar Media/CMAG ad data shows how Republicans in Arizona's competitive Senate race have focused on immigration and security issues in their TV advertising, while also emphasizing their pro-Trump bona fides. Those were the top three TV ad themes by spending through the week of August 21 -- "immigration" ($2.45 million), "pro-Trump" ($1.77 million), and "public safety" ($1.58 million).
One of the top ads from Rep. Martha McSally touches on all of these themes, particularly the race to be the most "pro-Trump" candidate. It's a critical issue for McSally, the establishment favorite, and a former Trump critic who is facing a robust Republican primary contest against two outsider candidates -- Kelli Ward and Joe Arpaio -- in the mold of Trump who have adhered to his brand of politics and seized on polarizing immigration issues.
In the spot, McSally says she's "working with President Trump to secure our border and keep Arizona families safe," promising to "crack down on sanctuary cities," "enforce the law," and "build the wall" on the US-Mexico border. The ad features a clip of Trump praising "my friend Martha McSally," and an Arizona Republic piece declaring McSally "Arizona's most reliable vote for the Trump agenda."
Another ad from One Nation, a pro-McSally conservative outside group, also focuses on immigration and security issues. "They illegally cross our border -- criminals, violent gang members, and drugs, putting us all at risk," a narrator says over images of the border and ICE agents, before praising McSally and fellow Arizona Rep. David Schweikert for their efforts on border security issues.
On the other side, Democrat Kyrsten Sinema and liberal outside groups have made health care central to their messaging. Democrats have spent over $3.46 million on "health care" ads, with "taxes" ($1.58 million) and "veterans affairs" ($1.1 million) the second- and third-most discussed topics.
In one of Sinema's ads, she recounts her family's struggle with health care costs. "We were just kids when my dad lost his job. We lost our car, we lost our home, and we lost our health insurance. I know what it's like for a family to struggle to make ends meet," Sinema says in the spot. "Health care needs to be more affordable."
Meanwhile, Red and Gold -- a mysterious super PAC with links to Arizona Democrats that formed close enough to the primary date to avoid disclosing its donors until after the contest -- has been one of the most active outside groups in the race, spending over $1.6 million on a wave of ads targeting McSally that include a number of health care spots. In one of those ads, a couple from Oracle, Arizona, detail their struggle with health care costs.
"Every month I write a check for our health insurance. It's out of control," Kim Schweitzer says in the ad. "It hurts." Larry, her husband, references McSally's vote for the GOP attempt at repealing Obamacare, saying: "Martha McSally voted for this five-time cost increase for health insurance. I mean, I don't know how anyone can afford it. I don't get it, I don't know what Martha McSally is thinking."
Across advertisers from both parties in Arizona, "health care" was the top issue by spending ($4 million), followed by "immigration" ($2.7 million), "taxes" ($2.1 million), "public safety" ($2.1 million), and "terrorism" ($1.77 million) and "pro-Trump" ($1.77 million).
In Florida, as in Arizona, health care has been the dominant TV ad theme -- though Florida has seen more than three times the amount of TV ad spending so far, despite lacking a competitive Senate primary in a race expected to pit incumbent Democratic Sen. Bill Nelson against outgoing Republican Gov. Rick Scott.
Across both parties, candidates and outside groups have spent $14.7 million on ads discussing health care (with $9.7 million of that total devoted specifically to ads about Medicare). Health care ad spending was ahead of "taxes" ($14.1 million), "Social Security" ($7.69 million), and "social issues" ($5 million) and "term-limits" ($5 million).
Broken down by party, Democrats have put the greatest emphasis on health care ($7.98 million), followed by "social issues" ($5 million), "call to action" spots ($2.9 million) and "Social Security" ($2.9 million).
For example, an ad from Senate Majority PAC, a leading Democratic outside group, features an ER doctor listing health care issues and criticizing Scott's policies as governor while praising Nelson's efforts. "We got an opioid crisis, a doctor shortage, seniors struggling to pay for care, but even with all that, Rick Scott vetoed millions in health care funds and refused federal health care funds that would have covered 750,000 Floridians. Bill Nelson took on the insurance companies, forcing them to cover people with pre-existing conditions," Dr. David Woolsey says in the spot.
And an ad from Majority Forward -- a group affiliated with Senate Majority PAC -- also hammers Scott for "veto[ing] nearly $200 million in health care funds" as governor, "slashing home health care for seniors and vaccinations for kids," and "cutting doctors at rural hospitals and treatment for opioid addiction" -- "instead, Scott backed his party and gave tax cuts to corporations and the wealthy," the ad's narrator says.
The Republican tax cuts, and tax policy generally, have been a key theme in GOP messaging in the Florida Senate race. Florida Republicans have spent $11.29 million on ads discussing taxes, while also stressing health care ($6.75 million) and "term-limits" ($5 million) -- a tactic conservatives have seized on to cudgel Nelson, a four-decade veteran of politics.
A top Scott ad hits Nelson over both the longevity of his Washington career and his opposition to tax cuts. "In 1978, the Ford Pinto was the best-selling small car in America, gas was 63 cents a gallon, and Bill Nelson was elected to Congress. Forty years later, a lot of things change, but Bill Nelson is still in Washington," a narrator says over a series of retro images. "349 times, he's voted for higher taxes."
Term-limits and Nelson's lengthy career are another recurring theme. An ad from New Republican PAC -- which has spent over $5 million on the ace so far -- ticks through Nelson's career, starting in 1972 when he was elected to the Florida legislature, and repeatedly criticizes him for liberal tax policies before closing with, "after 45 years, it's time to term-limit Bill Nelson."
The Republican approach to health care messaging in Florida, meanwhile, has been to target Democrats over the long-term viability of Medicare. One of Scott's ads argues that Democratic policies threaten the program's future: "You pay for Medicare your entire career -- your parents paid into Medicare their entire lives -- but Washington is letting Medicare crumble," a narrator says. "Bill Nelson voted to cut $716 billion from Medicare -- no wonder it's going bankrupt."