Numerous polls show health-careas the No. 1 issue for voters in the 2018 midterm elections andthat protecting those with pre-existing conditions isoverwhelmingly popular across party lines. (Photo:Shutterstock)

Numerous Republicans who are supporting attempts to dismantle Obamacare are simultaneouslycampaigning for election on their support for a core provision of the law.

The GOP spent the eight years since the Affordable Care Act waspassed attempting to derail it in Congress, the WhiteHouse and the courts. But those efforts have struck a nerve when itcomes to a central element of the law — rules protecting insurancecoverage for pre-existing conditions.

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It's put Republican candidates from conservative states andswing House districts on the defensive, and given an opening forvulnerable Democrats such as Missouri Senator Claire McCaskill andIndiana Senator Joe Donnelly to highlight a favorable contrast withtheir opponents. For McCaskill, Donnelly and other Democratsrunning in Republican-dominated states, the debate also is a chanceto talk about something other than their votes against SupremeCourt Justice Brett Kavanaugh, which energized GOP voters.

The issue illustrates the shift in health-care politics sinceRepublicans exploited antipathy to the 2010 law to win subsequentelections. This year is different, as numerous polls showhealth-care as the No. 1 issue for voters in the 2018 midtermelections and that protecting those with pre-existing conditions isoverwhelmingly popular across party lines.

Third rail

“It's remarkable how much the ACA and the efforts to repeal ithave made protections for people with pre-existing conditionssomething of a political third rail,” said Larry Levitt, seniorvice president for health reform at the nonpartisan Kaiser FamilyFoundation. “You'd be hard-pressed to find a candidate running foroffice right now who says they're against protections forpre-existing conditions, but whether they support actual polices tomake that protection a reality is a different question.”

Democrats running in states or districts where Trump won in 2016have zeroed in on the issue in their re-election campaigns.

McCaskill, one of the Senate Democrats most at risk on Nov. 6,has put the issue front and center in her campaign againstRepublican state Attorney General Josh Hawley. Hawley signed on toa lawsuit started by the Texas attorney general that aims toinvalidate the Obamacare law.

Missouri battle

“Josh Hawley decided to use your taxpayer dollars to file alawsuit that would take away important prescription drug coveragefor seniors through Medicare and end all of the consumerprotections under the ACA — including protections for Missourianswith pre-existing conditions such as asthma, high blood pressure,cancer or diabetes,” she wrote in an August op-ed for theSpringfield News-Leader. Since then, she has posted videotestimonials from more than two-dozen constituents who depend onthe consumer protections.

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Hawley last week released an emotional television ad in which hediscusses his son's chronic disease, and promises viewers: “Isupport forcing insurance companies to cover all pre-existingconditions, and Claire McCaskill knows it.”

Wanted to share a little about myfamily and our journey, and my commitment to protecting people withpreexisting conditions — like my son #MOSenpic.twitter.com/g7u9RzN1iO — Josh Hawley (@HawleyMO) September 24,2018

The backdrop for the debate is the unsuccessful attempt byPresident Donald Trump and a Republican-led Congress to replace theAffordable Care Act with legislation that would've weakened theconsumer regulations and, experts said, driven up costs forinsurance for sick people while lowering them for healthypeople.

Texas lawsuit

After those efforts failed, the Justice Department backed the Texas lawsuit, which seeks tooverturn the health-care law on constitutional grounds. The Trumpadministration, meanwhile, has taken regulatory action to expandthe use of short-term insurance plans that don't have to complywith pre-existing condition rules.

Hawley campaign spokeswoman Kelli Ford said he's supporting thelawsuit because he views the ACA's requirement that all individualshave health insurance as unconstitutional. She said Hawley “wantsCongress to mandate that insurance companies cover everyone withpre-existing conditions” but didn't say if he supports requiring aset of benefits to be included in policies.

In his own op-ed published last week, Hawley suggested requiringinsurers to offer plans at the same prices regardless of whetherthe consumer has or had an illness, and have the federal governmentstep in to help pay for costs above a threshold.

Shotgun blast

GOP Senate candidate Patrick Morrisey, West Virginia's attorneygeneral, has signed onto the Texas lawsuit. Joe Manchin, the onlyDemocrat to vote for Kavanaugh, has made that a centerpiece of hiscampaign. He's run a TV ad in which he fires a shotgun at a copy ofthe lawsuit, saying Morrisey would “take away health care frompeople with pre-existing conditions; he is just dead wrong.”

Donnelly and Montana's Jon Tester, another Democrat running in astate where Trump won, are also trying to capitalize on theissue.

Representative Dana Rohrabacher, a 15-term Republican whorepresents Orange County in California and faces perhaps histoughest re-election battle, released an ad last week saying thathe's “taking on both parties and fighting for those withpre-existing conditions.” Rohrabacher voted for his party'sObamacare replacement bill that included state waivers from rulesthat prohibit charging higher prices to people with pre-existingconditions.

For me, healthcare is personal. Whenit comes to preexisting conditions I'm using my heart as well as myhead, advocating a creative bi-partisan approach.https://t.co/nVYq3iKRqI pic.twitter.com/d2McgjE5Zg — DanaRohrabacher (@DanaRohrabacher) October 3, 2018

Trump has tried to counter by depicting himself as a championfor covering pre-existing conditions at recent rallies withRepublican candidates, including Morrisey.

“I will always fight for and always protect patients withpre-existing conditions,” he said on Sept. 29 in West Virginia.

Facing attacks

Republican Senate candidates who have faced attacks fromDemocratic opponents on the issue include Senator Dean Heller ofNevada, Governor Rick Scott of Florida, Representative Jim Renacciof Ohio and Representative Kevin Cramer of North Dakota. All ofthem have supported their party's efforts to unwind Obamacare.

Levitt and other health-care policy experts say thatpre-existing condition rules are unsustainable without mechanismsto expand participation and provide financial assistance.

Legislation has been offered by Senator Thom Tillis, a NorthCarolina Republican, as a contingency for pre-existing conditionsin the event the Texas lawsuit succeeds. Levitt said theprotections are “something of a mirage” as they'd allow insurers toexclude benefits under some circumstances and charge higherpremiums.

Another bill by House Energy and Commerce Chairman Greg Walden,an Oregon Republican. doesn't accomplish its stated goal ofpreventing higher premiums for pre-existing conditions, Levittsaid.

'Details matter'

“The details matter enormously in insurance regulation,” hesaid.

Texas Representative Pete Sessions, locked in a competitivere-election race, helped shepherd the bill through the House asRules Committee chairman that would open the door for insurers toraise costs for covering pre-existing conditions. He's backed awayfrom that by offering a separate bill with some protections as wellas proposing a nonbinding resolution that calls for lower premiums,out-of-pocket costs, and more provider choices to people withpre-existing conditions.

The Sessions resolution was co-signed by Renacci and Cramer.Other signatories include GOP candidates facing difficultre-election challenges, including New York's Claudia Tenney,Michigan's Mike Bishop and New York's John Faso, all of whom havetaken heat for supporting the Republican-backed American HealthCare Act, which passed the House and stalled in the Senate.

Some Republicans are counter-attacking by claiming Democrats arepushing to replace private insurance with a government-run healthsystem, something most of the party hasn't embraced. House SpeakerPaul Ryan on Monday said the debate is presenting a “false choice”because everyone supports protections for pre-existingconditions.

Health-care premiums have been on the rise in recent decades,before and after the ACA, squeezing middle-class families. Manyobtained coverage for the first time after the law passed,including those with pre-existing conditions who had been shut outof the market. The uninsured rate among non-elderly adults fellfrom 18.2 percent to 10.3 percent since 2010, according to anAugust estimate by the Kaiser Family Foundation.

Even Republicans who voted against the House GOP bill are facingattacks because of the actions of their party leaders. An ad fromDemocrat Jennifer Wexton derisively labeled Virginia RepublicanRepresentative Barbara Comstock “Barbara Trumpstock” and depictedher as being “against protections for pre-existing conditions. Shevoted against her party's House legislation.

Read more about the political debate over healthcare:

• Why the future of the ACA could be decided at themidterm elections
• GOP senators working to save pre-existingconditions
• 'Nothing is safe.' How the ACA is impactingattorney general races

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