WASHINGTON — Republican senators facing tough re-election fights this fall are expressing support for insurance protections for people with pre-existing medical conditions, running ads at odds with their own recent votes and policy positions.
The latest example came Tuesday when Sen. Cory Gardner, R-Colo., who has voted repeatedly to repeal the Obamacare law that established those federal protections, released an emotional ad in which he sits with his mother and discusses her successful battle with cancer.
"Cory wrote the bill to guarantee coverage to people with pre-existing conditions — forever," she says, looking directly at the camera.
"No matter what happens to Obamacare," the senator adds.
But experts say the bill he cites doesn't do that.
Gardner is one of several Republicans to obscure their record on pre-existing conditions as rising public support for Obamacare turns the issue into a liability for senators who have voted to repeal it.
Republican senators are fighting to maintain control of the chamber, and that has left many telling voters they favor the most popular provisions after they backed legislation that would have chipped away at the protections in the 2010 law. The replacement plans they've supported fall short of fully restoring those rules, say health policy experts.
"When you're in retreat it's best to do it slowly and not make it look like a complete spin around," said Tom Miller, a health policy expert at the conservative American Enterprise Institute.
Gardner’s 117-word-long legislation would require insurers "not impose any pre-existing condition exclusion" or "factor health status into premiums or charges.” The bill was introduced in August and has never received a hearing or a vote.
Larry Levitt, the executive vice president for health policy at the nonpartisan Kaiser Family Foundation, said Gardner's bill "contains a giant loophole" because insurance companies can simply "deny coverage altogether to people with pre-existing conditions."
The current rules, created through the Affordable Care Act, include “guaranteed issue,” meaning insurance companies have to sell policies to people regardless of health status, Levitt said in an email.
"The Gardner bill leaves out that requirement, meaning that insurers could deny coverage to people with pre-existing conditions, as they commonly did in the individual insurance market before the ACA," he said.
Gardner campaign spokesman Meghan Graf didn't respond when asked if Gardner still favors ACA repeal, or why his bill doesn't include the guaranteed issue provision. She wouldn’t say whether Gardner supports a lawsuit backed by the Trump administration to invalidate the ACA.
Miller said GOP senators are running these ads because they can read polls that show pre-existing condition rules are popular and "don't want to get crosswise" with voters. He said there are other ways to protect sick people, but each come with some downsides.
"I don't think a lot of Republicans have thought deeply and consistently about how to do that because that takes work. It's heavy lifting and it requires trade-offs," Miller said.
'ADVANCE TO THE REAR'
Sen. Martha McSally, R-Ariz., who also faces a difficult re-election, released an ad in June rebutting her Democratic opponent's criticisms of her health care record.
"Mark Kelly's attacks on me are false. And they're shameful. Of course I will always protect those with preexisting conditions. Always," she said to the camera.
But as a member of the House in 2017, McSally voted for legislation that would unwind much of the ACA and allow states to apply for an exemption from rules that prohibit insurers from charging people more if they have a pre-existing condition.
Experts noted at the time that the waivers could pave the way for insurance companies to jack up costs and price sick people out of the market. (It passed the House but died in the Senate.)
Several Republicans who voted to advance that effort in the Senate have also released ads proclaiming their support for people with pre-existing medical conditions.
And they are making their statements deeply personal, with several including family members who have overcome health challenges.
In an ad released in August, Sen. David Perdue, R-Ga., who is also in a tight battle for re-election, says: "Health insurance should always cover pre-existing conditions. For anyone. Period." The spot includes his sister, a cancer survivor, who says she is defending "my big brother's heart" on the issue.
In Montana, Sen. Steve Daines, a Republican who is facing a strong Democratic opponent in Gov. Steve Bullock, ran an ad in July featuring a woman who said, "Steve Daines will protect Montanans with pre-existing conditions."
Perdue and Daines voted to advance the Senate repeal-and-replace measure in 2017. Daines also voted to repeal the ACA without a replacement as a member of the House in 2013.
On his official website, Daines says, "I support full repeal of Obamacare," and adds that "we must always protect those with preexisting conditions," without getting specific.
Miller, of AEI, thinks Republicans are doing what in military terms is known as "advance to the rear," suggesting they are retreating while claiming otherwise.
"A lot has changed since the rhetorical barking in opposition [to Obamacare] from 2009 to 2016, and even in the ambitions of what they'd do legislatively since 2017," Miller said.