When Rep. Mike Turner, R-Dayton, sent out a campaign mailer telling voters he’s working to guarantee private insurance for people with pre-existing conditions, Democratic opponent Theresa Gasper snapped that Turner is “hoping to dupe voters about his record.”
In Columbus, Democrat Rick Neal made a similar charge about Republican Rep. Steve Stivers of Upper Arlington. The Democratic attack lines are aimed at drawing attention to GOP efforts to repeal the Affordable Care Act, the 2010 health care law that barred insurance companies from excluding people with prior medical histories.
Health care again is a key election issue, but the messaging is a little different this year.
For years House Republicans could call for repealing the law, commonly known as Obamacare, without paying much of a political price. Between 2011 and 2016, the Republican-controlled House voted more than 40 times to either scrap or dramatically scale back the law. It was essentially a free vote because neither the Senate nor President Barack Obama would agree to dismantle the law.
But with polls showing a majority of voters approving of Obamacare — particularly the prohibition on insurance companies denying coverage to patients with pre-existing conditions — many Republicans are touting their efforts to protect people from losing their health insurance.
“People are trying to say their vote to repeal the Affordable Care Act was a vote to protect people with pre-existing conditions,” said Tony Carrk, deputy director of Protect Our Care, a left-leaning organization that wants to keep the law. “You’re seeing a lot of rewriting history.”
Rodney Whitlock, a former GOP health care policy aide, doesn’t quite see it that way, though he admits that Democrats have put Republicans on the defensive.
“Democrats have done a very good job saying Republicans oppose covering pre-existing conditions and Republicans have not done a good job explaining why they’re wrong,” said Whitlock, who is now vice president of health at ML Strategies. “And that’s why Republicans are in the position they’re in.”
Stivers last year joined joined House Republicans in a vote to repeal Obamacare and substitute a more market-oriented version, which also prevented insurance companies from denying coverage to those with pre-existing conditions.
But there was a loophole. States could ask to opt out of “community ratings,” which require insurance companies in a particular geographic area to charge the same premiums to all people, no matter their health condition. That meant that while the bill required insurance companies to cover pre-existing conditions, sometimes the policies were so expensive that those seeking those policies would effectively be priced out of having coverage.
To fight that, states receiving a waiver would have to establish high-risk pools for people subject to higher premiums or a re-insurance program that hopefully would lower premiums. The House bill provided $138 billion for states to establish those risk pools.
Turner voted against the legislation, saying the bill would “leave our most vulnerable citizens with inadequate health coverage.” He has cosponsored two bills aimed at protecting people with pre-existing conditions, but the bills have remain stalled in committee.
“I ultimately could not support the American Health Care Act. This bill will leave our most vulnerable citizens with inadequate health coverage,” Turner said at the time. “I cannot support a health plan to replace Obamacare that puts my constituents’ health benefits at risk.”
Karen Pollitz of the Kaiser Family Foundation, a research nonprofit that focuses on health care policy, said high-risk pools were used by some states prior to the Affordable Care Act becoming law. One of the measures states used to keep the costs of those pools down was to exclude coverage of pre-existing conditions for specific periods of time, Pollitz said.
In some ways Democrats have benefitted by the simplicity of their messaging: Republicans voted to repeal the very law that includes protections for people with pre-existing conditions.
And Carrk said Republicans may have helped that narrative along with a lawsuit, brought by about 20 GOP-led states, which seeks to eliminate the entire health care law. The Trump administration also announced earlier this year that it would not defend the law in court.
Whitlock said the lawsuit’s principle argument — that the Affordable Care Act usurps a state’s authority to regulate health care — is legitimate, but a little hard to fit into a 30-second campaign ad.
“We’re days away from an election, so there is no gray,” he said. “It’s only black or white, good or evil.”
Alex Conant, a Republican consultant in Washington, said “if Democrats can convince voters that Republicans want to take away their health care, that can be very effective.”
“The Democrats are taking a lot of liberties with the facts, but Republican messaging on health care has been inconsistent in that we spend a lot of time talking about what we don’t like about Obamacare, but we have not spent enough time talking about what a replacement would look like,” Conant said.
Other GOP strategists such as Barry Bennett insist the Democrat attacks are “preposterous.”
“It’s not convincing anybody except their own base,” Bennett said. “Steve Stivers has never said anything that he doesn’t support pre-existing conditions. To say that he has is kind of a lie.”