Republicans Are Suddenly Running Ads on Pre-existing Conditions. But How Accurate Are They?


It’s a sign of the issue’s importance that several candidates in close races are feeling pressure to respond.

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The longtime California congressman Dana Rohrabacher with his family in his recent health care ad. His stated commitment to protecting pre-existing conditions is not a great match with his legislative record.

For months, Democratic candidates have been running hard on health care, while Republicans have said little about it. In a sign of the issue’s potency, Republicans are now playing defense, releasing a wave of ads promising they will preserve protections for Americans with pre-existing health conditions.

The ads omit the fact that the protections were a central feature of the Affordable Care Act and that the Republican Party has worked unceasingly to repeal the law, through legislation and lawsuits.

Republicans in Congress have recently come forward with limited legislative proposals to ensure some pre-existing conditions protections if the health law is overturned. One, a House resolution, would have no force of law, even if adopted. The other would contain a significant loophole: Insurers would have to cover those with pre-existing illnesses, but would not have to cover care for those particular illnesses. (Neither is on track to become law.)

As with some Democratic advertisements, several ads by Republicans feature family members with health problems. Some directly respond to criticisms offered by a Democratic rival. Many cite votes for Republican bills that would have overhauled large portions of Obamacare last year — the very same votes that Democrats have been using as evidence that Republicans want to limit health coverage.

Protection of pre-existing conditions is popular, and surveys suggest that voters trust Democrats more than Republicans on health care. A few months ago, Republican candidates were happy to focus their messages elsewhere — on the economy, or immigration policy. They are now defending themselves on less friendly territory.

Here are a few of this new crop of G.O.P. ads and some context.

The Republican candidate: Josh Hawley, Missouri’s attorney general, is challenging the incumbent, Senator Claire McCaskill.

The ad: A tight shot of Mr. Hawley talking into the camera is cross-cut with images from a field where his family and children are playing with brightly colored soccer balls. Mr. Hawley describes how one of his “two perfect little boys” has a rare disease that would be considered a pre-existing condition. “We know what that’s like,” he says, before saying that he supports “forcing insurance companies” to cover pre-existing illnesses. The boy kicks a ball across the field.

The strategy: Mr. Hawley is among a group of G.O.P. officials from 20 states who have brought a lawsuit challenging the constitutionality of the Affordable Care Act. If the suit succeeds, the entire law, including its guarantees of affordable coverage for Americans with prior illnesses, could be eradicated. (The Trump administration has argued in court that most of the law should stand, but its pre-existing conditions protections, alone, should be invalidated.) Ms. McCaskill has been using Mr. Hawley’s participation in the suit as a central line of attack in her campaign, and has highlighted her personal experience with breast cancer.

Mr. Hawley says he supports protections for those with pre-existing conditions, but it’s not clear whether the policies he supports would provide the same protections that people like his son currently enjoy. If his lawsuit invalidated the entire health care law, it would return the country to a time when people with prior illness sometimes couldn’t buy coverage at all. Republicans could pass a law restoring Obamacare’s consumer protections, but Mr. Hawley has not yet explicitly endorsed such a strategy.

In an interview this summer, Mr. Hawley said he supported unspecified policies to protect such customers and to allow young adults to remain on their parents’ health plans. “We can do those things apart from the structure of Obamacare,” he said, recommending a less stringent set of regulations on insurance benefits.

Last year’s Republican repeal bills provided some protections for people who remained insured without interruptions in coverage. But they would have permitted insurance companies in some states to avoid covering certain types of medical treatments or to charge higher prices to sicker customers who had let their coverage lapse.

The Republican candidate: Dana Rohrabacher is an incumbent congressman from California’s 48th District who has served in the House since 1989. He is being challenged by a lawyer and real estate businessman, Harley Rouda, in a very close race.

The ad: Mr. Rohrabacher stands beside his wife, while his daughter, Annika, sits on a swing. Mr. Rohrabacher explains why health care is “personal” for his family: “When my daughter Annika was 8 years old, she was afflicted with leukemia. It was devastating for my family, but she got through of it.” Photos of Annika in a hospital bed and a wheelchair are replaced with video footage of the Rohrabacher family walking along a beach (Mr. Rohrabacher wears a wet suit and carries a surfboard).

“That’s why I’m taking on both parties and fighting for those with pre-existing conditions,” he says, shaking a fist. After Mr. Rohrabacher says he endorses the ad, Annika adds: “And so do I.”

The strategy: Mr. Rohrabacher really does have a novel strategy to try to protect Americans with pre-existing conditions, one that is at odds with the dominant approaches of both political parties. His proposal, explained in an op-ed this summer, would allow commercial plans to avoid covering pre-existing illnesses, but allow affected patients to get Medicare coverage for those ailments alone. The ad casts Mr. Rohrabacher as a creative and nonpartisan lawmaker, with a personal interest in health care, rather than one who follows Republican leaders.

But when it came to more realistic choices for managing the health care system, Mr. Rohrabacher also voted for the American Health Care Act last year, a bill that would have upended large parts of Obamacare. The bill would have made large cuts to the Medicaid program, which covers many American children, and weakened protections for patients with prior illnesses in states that pursued waivers of Obamacare’s usual rules. His unusual proposal appears to tie his support for that bill with his commitment to Americans like his daughter. But his commitment is an imperfect match with his legislative record.

The Republican candidate: Dean Heller, a Republican Senator from Nevada, is in a close race for re-election against Jacky Rosen, a congresswoman from the state’s Third District.

The ad: To understand this advertisement, you almost need to have seen Ms. Rosen’s attack ad against Mr. Heller, which compares him to an inflatable tube man, spineless and floppy, as it describes his shifting positions on last year’s Obamacare repeal effort.

Mr. Heller’s ad shows the tube man waving on a screen beside a television camera and a director’s chair labeled ROSEN. “Jacky Rosen’s idea of fixing health care: a campaign commercial,” Mr. Heller says, as the camera zooms out. Mr. Heller criticizes Ms. Rosen for failing to advance health care legislation, saying: “I’m fighting to protect pre-existing conditions and increase funding for Nevadans who need it most. Jacky, I’ll stack my record up against yours any day.” The commercial closes with another shot of the tube man.

The strategy: Mr. Heller found himself in a tough spot when Republican repeal bills came to the Senate floor last year. Republican leadership really needed his vote to advance a bill, and he had promised as a candidate to repeal Obamacare. But Nevada’s governor opposed the legislation, saying it would hurt the state. First, Mr. Heller opposed the Senate bill. Ultimately, he voted for a more stripped-down plan that would have kept pre-existing condition protections while eliminating other key parts of Obamacare. (He also noted his support for a bill that would have replaced Obamacare’s insurance markets with a block grant program to states that would have allowed them to eliminate pre-existing conditions protections altogether.)

It is true that Mr. Heller has advanced more pieces of health legislation in the last Congress than his opponent. He was, after all, part of the Republican majority that controlled the legislative agenda. But neither of the health care bills Mr. Heller cites in his ad has become law, and it’s questionable whether their effects would match his claims in the ad. These are the same bills and votes that Ms. Rosen has cited as evidence that Mr. Heller would pare back health coverage. The reference to Ms. Rosen’s ad suggests it has been memorable enough to voters to merit a response.

The Republican candidate: Kevin Cramer, North Dakota’s congressman, is running to unseat a Democratic senator, Heidi Heitkamp.

The ad: There are cows. “Come on, Heidi, the word’s out,” the ad’s narrator says, citing news reports fact-checking aspects of Ms. Heitkamp’s ads that criticized Mr. Cramer’s health care record. “It’s a stampede,” the voice says, as cows trot across the screen, pursued by a cowboy with a lasso. (Side note: Is this a stampede?) The narrator explains that “Kevin Cramer voted for guaranteed coverage for pre-existing conditions.” Ms. Heitkamp’s health care advertisements, the narrator says, “don’t pass the smell test.” Then a cow moos.

The strategy: Like Mr. Heller, Mr. Cramer is trying to characterize his votes to repeal Obamacare as efforts to preserve protections for pre-existing conditions — and he is responding to Democratic ads highlighting the issue. That claim is a bigger stretch for Mr. Cramer than it is for Mr. Heller, despite some quibbles with details of Ms. Heitkamp’s ads. Mr. Cramer voted to support the American Health Care Act, a bill that would have allowed states to weaken protections for Americans with pre-existing conditions. If the bill had become law, North Dakota might have preserved Obamacare’s rules, but that is different from “guaranteed coverage.”

Mr. Cramer also recently co-sponsored a nonbinding House resolution that argues that pre-existing condition protection should be in future health overhaul bills. That suggests Mr. Cramer is engaged on the issue, but that also is different from a guarantee.

Margot Sanger-Katz is a domestic correspondent and writes about health care for The Upshot. She was previously a reporter at National Journal and The Concord Monitor and an editor at Legal Affairs and the Yale Alumni Magazine. @sangerkatz Facebook



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