Rep. Lizzie Fletcher during a panel discussion on health care in western Houston on Feb. 19, 2020.

Jacob Pramuk | CNBC

HOUSTON — As Democratic presidential hopefuls gathered in Nevada last week to slug it out over socialism, wealthy donors and sexual harassment, Rep. Lizzie Fletcher wanted to talk about drug prices.

The first-term Democratic congresswoman, who flipped a seat here held for decades by Republicans including President George H.W. Bush, led a Feb. 19 panel on how to slash pharmaceutical costs. She repeatedly highlighted H.R. 3, the bill passed by the new Democratic House majority designed to cut prices by allowing the U.S. government to directly negotiate with drugmakers.

Fletcher fielded constituent questions about affording pricey medicine that’s more effective than alternatives — but not covered by insurance.

Attendees asked about the availability of cheaper generic drugs. One constituent extolled the achievements of pharmaceutical companies, prompting another to shoot back, “Are you a lobbyist?”

The Houston area, and a changing Texas more broadly, sit at the center of Democrats’ effort to keep or tighten their grip on House control in November. As voters in the party’s presidential primary decide whether they want a far-reaching overhaul of the economic and political system or more gradual change, the party’s House candidates in battleground districts have mostly tried to block out the national noise as they attempt to dig farther into GOP territory.

‘Health care, health care, health care’

During the panel, Fletcher said she opposes a single-payer “Medicare for All” system, which Democratic presidential front-runner Sen. Bernie Sanders champions, and favors “incremental” rather than “revolutionary change” on health care. Even as Sanders and other progressives gain traction here and around the country, the Democrats in Texas’ key House races are sticking to the strategy that helped the party regain the chamber in 2018.

“When we are thinking about how best to represent our districts, it starts with listening and then working to actually solve the problems. And that’s what you’re seeing the House do right now,” Fletcher told CNBC last week when asked about how the primary outcome or a Sanders nomination could affect her strategy in November.

“Health care, health care, health care” is what House Speaker Nancy Pelosi reportedly told her caucus to run on as members seek reelection this year. In Texas, primaries in the next week’s Super Tuesday will start to set the field in swing races that will help to determine which party controls the House next year.

Some Republicans running to represent those districts are trying to use Sanders’ early triumphs in the presidential primary against Democrats like Fletcher, who have tried to craft independent brands. The strategy will likely spread if the Vermont senator continues to gain steam in upcoming primaries, including Saturday’s South Carolina vote.

Two of Sanders’ Democratic rivals, Joe Biden and Pete Buttigieg, have also argued the self-professed democratic socialist will hurt candidates down the ballot. Sanders has argued the energy behind his platform, which includes universal health care, blanket student debt forgiveness and free child care for all, will mobilize younger and more infrequent voters to put him over the top.

This year, Democrats will defend two highly sought-after House seats in Texas that they picked up in 2018: Fletcher’s 7th District and the Dallas-area 32nd District held by Rep. Colin Allred, who has supported Biden. The party will target at least six other GOP-held districts in the Lone Star State. Republican retirements made several races more competitive.

Three of the battleground seats stretch either into or near Houston, the nation’s fourth-largest city. Its suburbs, like parts of Fletcher’s district that have grown more diverse, younger and better educated, embody traditionally Republican pockets of the country where Democrats made gains in 2018 and hope to further cut into GOP power this year.

“This district has changed dramatically demographically. … This no longer your Anglo, country club constituency,” Renee Cross, senior director of the Hobby School of Public Affairs at the University of Houston, said of the 7th District.

Next door sits the 22nd District. The seat, vacant and hotly contested this year following GOP Rep. Pete Olson’s retirement, includes major parts of Fort Bend County, the most diverse county in Texas.

Sri Kulkarni, a Democrat who lost to Olson by about 5 percentage points in 2018, will take another crack at the open seat this year. In what the former State Department official and son of an immigrant described as a rapidly changing district, his campaign has reached out to voters in 15 languages from Hindi to Vietnamese and Igbo.

Kulkarni ran on health care in 2018 and describes it as voters’ top priority again this year.

“The issues are still the same. Health care is still the number one issue, bringing down the cost of health care, bringing down — negotiating prescription drug prices, making sure everyone has access and mental health access, by the way,” he told CNBC, while highlighting gun safety, climate change and the region’s flooding as other priorities.

The GOP push

Republicans have channeled renewed energy into reclaiming or holding the Houston-area seats. Six GOP candidates are trying to challenge Fletcher in November.

In the 22nd District, more than a dozen Republican hopefuls aim to succeed Olson. If no candidate gets a majority in the primaries, runoffs will take place in May.

Tuesday’s primary in the 22nd offers a referendum of sorts on the future of the Republican Party in the increasingly diverse area. Leading candidates include Pierce Bush, grandson of George H.W. Bush whose family name has lost luster in Trump’s GOP, and Kathaleen Wall, a Republican donor who has used her own money to fund a message of loyalty to the president.

While Democratic campaigns have clobbered Republicans in House swing-district fundraising, one of the leading candidates in the 7th has been a bright spot for the GOP. Wesley Hunt, an Army veteran backed by President Donald Trump, took in an impressive haul of nearly $550,000 from individuals from Jan. 1 to Feb. 12 (though Fletcher ended the period with more than twice as much as he had in the bank).

Republican congressional candidate Wesley Hunt walking between knocking doors in the Tanglewood neighborhood in western Houston on Feb. 19, 2020.

Jacob Pramuk | CNBC

The other leading Republican in Tuesday’s primary is Cindy Siegel, the former mayor of the affluent Houston suburb of Bellaire.

In interviews with CNBC, Hunt and Siegel aligned on most key issues. They both want to repeal and replace Obamacare, back selling insurance across state lines and increasing price transparency to cut health costs. The Republicans support Trump’s border wall and lower taxes.

They have looked for different ways to set themselves apart in the primary. Hunt has emphasized his military service, saying, “I’m somebody that’s risked my life for this country, to defend it, already.” His campaign has dipped into its coffers to run ads promoting his time in the military and his family history: His latest ad highlights how his African American family went from “slavery to West Point in five generations.”

Siegel has touted her experience as a local official and a certified public accountant. “There’s no one else in the race that has my Republican credentials,” she said. Saying she votes in Republican primaries, she said “not all the opponents have done that in the primary.”

The issue came up last week when Hunt knocked doors of homes on the tree-lined streets of western Houston’s Tanglewood neighborhood. Two voters had heard from a friend concerned that Hunt did not vote in some past GOP primary elections.

Hunt told them he did not vote because he was serving overseas. Asked about his plan for the district, he said he would defend the energy industry “tooth and nail.” After an extended back-and-forth, the voters ultimately said they would support him in the primary.

The Green New Deal and the energy industry

The fossil fuel industry plays an enormous role in Houston’s economy. Texas produces more oil and natural gas than any other state. In the 7th District, its presence is as evident as anywhere: Driving along the area’s Energy Corridor, near strip malls, car dealerships and gleaming apartment complexes, stand the ConocoPhillips headquarters and offices for Shell and BP.

Beyond sitting at the forefront of Texas’ demographic changes, Houston embodies two of the core political challenges of the coming years: the future of the energy industry and the fight against climate change. The city is still recovering from the battering it received from Hurricane Harvey in 2017 and subsequent flooding.

It’s another policy area where Sanders could loom large over Texas as the presidential nominee. He has appealed to younger voters and climate activists by supporting the Green New Deal, an ambitious plan to create jobs while transitioning to renewable energy, banning fracking and offshore drilling and offering pay and training to displaced fossil fuel workers.

Hunt has repeatedly criticized the Green New Deal as dangerous for the area’s economy. He has also argued that, by supporting Pelosi as speaker, Fletcher made the area’s energy industry more vulnerable.

Fletcher has opposed bans on fracking and offshore drilling and has also argued against the Green New Deal. She told CNBC she understands and cares about the energy economy and making sure Houston “stays the energy capital of the world.”

In the 22nd District, Kulkarni said he backs “evidence-based policy” that involves investing in renewable energy and reducing dependence on fossil fuels — but not swearing off those sources.

“I have lots of supporters who are in BP, Schlumberger, my mom worked in Exxon. Everybody around here is somehow connected to the oil and gas industry, you know? There’s nobody I know, Democrat or Republican, who’s talking about cutting out the fossil fuel industry completely,” he said.

“There’s also nobody I know who thinks that climate change is a Chinese hoax, like the president said,” he added.

For all the focus on Sanders nationally, Trump at the top of the ticket will have a massive effect on the races. Uneasiness about the president’s health care and immigration plans among a chunk of independents and Republicans contributed to Fletcher and Allred’s victories in Texas in 2018.

While the University of Houston’s Cross thinks a Sanders nomination could cause some difficulties for House candidates in Texas, she also expects many voters in key districts will not vote straight down the party line.

“I think we’re going to see a lot of split-ticket voting, particularly in districts like 7 and 22 and Colin Allred’s district,” she said.

— Graphics by CNBC’s John Schoen

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