As the year winds down, STAT reporters are taking a look at the stories they’re most eager to track in 2018. Find all our “three to watch” series here

Among the many issues Democrats hope to use to their advantage before the 2018 midterm elections — think Russia, a controversial tax overhaul, and a broader referendum on President Trump’s time in the White House — expect to see health care at or near the top of the list.

The Senate came a vote away in August from repealing the Affordable Care Act. Congress has yet to reauthorize the Children’s Health Insurance Program, and the sweeping tax bill it approved in late December is likely to destabilize current ACA exchanges via a repeal of the law’s individual mandate.

Health care discussions are happening in every corner of D.C., and there’s little doubt they will continue to play out next year as Democrats and Republicans fight for control of Capitol Hill in November.   

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Here are three 2018 campaigns to watch to determine what American voters make of how health care policy is being shaped in Washington.

Fred Upton defending Michigan’s 6th Congressional District

Upton, the onetime chairman of the House Energy and Commerce Committee, might be in trouble in Michigan’s 6th District — in large part because of health care. He brokered an $8 billion compromise that allowed House Republicans to coalesce around a bill that would have repealed the Affordable Care Act.

In a district where Republicans hold just a six-point registration advantage, in a traditionally blue state that flipped to Trump in 2016 but expanded Medicaid under the ACA just three years ago, that could prove an issue. And appropriately, one of Upton’s most serious Democratic challengers is a doctor: Matt Longjohn, formerly the YMCA’s national health officer who spearheaded a preventive health program shown to reduce new cases of type 2 diabetes among its 8,000 participants by at least 58 percent.

If Upton can’t win reelection to the seat he’s held since 1987, it’s a sign that Democrats are riding a major wave — and that health care is the biggest reason.  

Evan Jenkins challenging Joe Manchin for his Senate seat in West Virginia

West Virginia was Trump’s best state in 2016, which puts Sen. Joe Manchin, a Democrat, in a tough spot — he won’t brand himself as an oppositional figure to the president, even though he’s voted against Trump’s signature priorities like ACA repeal and a controversial tax overhaul.

West Virginia is also among the states most in need of federal dollars to bolster addiction treatment and prevention. Manchin has been vocal about opioid crisis issues — but so has Rep. Evan Jenkins, the Republican who represents the state’s 3rd District in the House and former executive director of the West Virginia State Medical Association, who is among the numerous GOP candidates hoping to flip the seat.

Another challenger is the state’s attorney general, Patrick Morrisey, who has previously weathered controversy for his work as a lobbyist and his financial ties to Cardinal Health. If Jenkins prevails in the primary, the language he uses in challenging a Democrat whose party is pushing a $45 billion proposal specific to addiction treatment will be telling. Also key: Jenkins’s justification for supporting the American Health Care Act, which passed the House in May and would have resulted in substantial reductions in future Medicaid spending.

Ed Royce defending California’s 39th Congressional District

The California 39th is yet another district with a Democratic doctor challenging a long-tenured Republican, and largely citing efforts to repeal the Affordable Care Act as her biggest inspiration to run.

In this case, it’s Mai Kanh Tran, a pediatrician in Orange County — a traditional Republican stronghold — hoping to unseat Rep. Ed Royce, who has served in the House since 1993. Tran announced her run in June, a month after Royce’s yes vote on the House’s ACA repeal bill.

This race is less important for the seat itself and more important because, like Upton’s reelection bid in Michigan, a liberal doctor winning a traditionally GOP-held seat in Orange County will represent a sea change in how voters everywhere allow health policy to influence their political preferences.  

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