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2018 midterm elections: Preexisting conditions, healthcare fight



trump doctorDrew Angerer/Getty Images

  • Healthcare is emerging as one of the dominant issues in the
    2018 midterm elections.
  • In particular, protections for people with preexisting
    conditions has become a key point of debate between Democrats and
  • Democrats argue the GOP’s attempts to repeal Obamacare would
    have undermined preexisting condition protections.
  • Republicans say they want to protect preexisting conditions
    while providing more choices for consumers.
  • Complicating the matter is a pending lawsuit against the ACA
    brought by 20 Republican state attorneys general.
  • Polls show that voters trust Democrats more on the issue.

Healthcare is
at or near the top of many Americans’ lists
of the
most important issues
in the 2018 midterm elections. 

And the healthcare fight between the two parties seems to be
coming down to one issue in particular: protections for people
with preexisting conditions.

Democrats are hammering their GOP opponents, arguing the
Republican’s repeated attempts to repeal the Affordable Care Act
would have undermined protections for sicker Americans. The GOP
argues that preexisting condition protections have always been a
part of their healthcare platform. 

President Donald Trump last week pledged that all Republicans
believe — or would believe — in protecting people with
preexisting conditions.

All Republicans support people with pre-existing
conditions, and if they don’t, they will after I speak to them,”
Trump tweeted Thursday. “I am in total support.”

Here’s what the preexisting condition fight is about

Prior to the Affordable Care Act becoming law, insurers were able
to deny people coverage due to a preexisting condition in many
states. And in most states, even if insurers did offer plans to
sick people, the companies could drive up premiums for people
with preexisting conditions.

The ACA’s preexisting condition protections mostly helped people
in the individual health insurance market — Americans who did not
receive coverage from a job or a government program like

The ACA created two major preexisting condition protections that
were created under the ACA:

  1. Guaranteed issue: This provision made it so insurers were
    compelled to offer insurance to people with preexisting
  2. Community rating: This prevents insurers from charging people
    with preexisting conditions much higher rates than healthy people
    and pricing those people out of the market.

While Republicans called for the complete repeal of Obamacare,
many eventually recognized the popularity of the preexisting
condition protections.

The GOP adopted guaranteed issue as part of their policy, but
community rating got a bit trickier in the rollout of the
American Health Care Act — the House GOP’s proposed ACA

  • Under the AHCA, states could apply for waivers that would
    weaken the community rating provision and allow insurers to
    charge based on health status — such as a preexisting condition —
    if a person did not maintain continuous insurance coverage.
  • States that received waivers could apply for funding to help
    alleviate the increased costs for people with preexisting
  • But many health policy experts viewed the
    amount of funding set out under the AHCA
    as inadequate. They warned that increased
    cost to sick Americans would result in many people with
    preexisting conditions being

    priced out of the market altogether
  • According to a study by the Kaiser Family Foundation, a
    nonpartisan health policy think tank, the AHCA could have left

    as many as 6 million people
    with preexisting conditions without

Democrats argued the inclusion of the waivers showed the GOP
would unnecessarily weaken protections for people with
preexisting conditions, while Republicans said the law was
designed to protect sick Americans while also driving down costs
for healthier people in the Obamacare marketplaces.

The looming lawsuit

Clouding the midterm fight is a pending lawsuit brought by the
Texas attorney general that could fully undo Obamacare’s
preexisting conditions protections.

The Texas attorney general and 19 other Republican state
attorneys general
are arguing in federal court
that since the GOP’s tax law
effectively repealed Obamacare’s mandate that all people buy
insurance, it is now unconstitutional. The AGs further argue that
if the mandate is unconstitutional then all of Obamacare —
including the popular protections — are also unlawful.

The lawsuit has puts many Republican candidates in a bind as

their states actively attempt
to repeal the preexisting
conditions in court while they try to convince voters of their
desire to uphold those same protections.

Screen Shot 2018 10 22 at 9.54.39 AM
Joe Manchin aims a shotgun at a copy of the ACA repeal lawsuit
Democrats argue would gut preexisting condition protections in a
campaign ad.


Two GOP senate candidates — Josh Hawley in Missouri and Patrick
Morrisey in West Virginia — are the attorneys general in their
states and are signed onto the lawsuit. Democrats Claire
McCaskill and Joe Manchin — the incumbents in Missouri and West
Virginia, respectively — have hammered their counterparts on the
issue and it could help them hold their seats in otherwise red

Manchin even
dramatically shot a copy of the lawsuit
with a gun in a
eye-catching campaign ad released in September.

Republicans scramble to win over voters

According to a poll from the Kaiser Family Foundation released
58% of Americans say they more trust Democrats
continue preexisting condition protections, while just 26% of
people say they more trust Republicans. Other polls have shown a
similar trend.

Given the discrepancy, Democrats are leaning into the issue:

  • 54.5% of
    all Democratic ads
    feature healthcare as the main issue,
    according to the Wesleyan Media Project.
  • Democratic leaders Chuck Schumer and Nancy Pelosi doubled
    down on the party’s healthcare message in a joint statement
    Saturday. “Democrats are focused
    like a laser on health care and will not be diverted,” the top
    Democrats said.

But amid the flood of healthcare ads from Democrats, the GOP has
attempted to fight back.
Many candidates
are pointing to their
personal experiences with family members
that have a
preexisting condition and leaning on the AHCA’s guaranteed-issue
provision as proof that the party wants to provide coverage for
people with preexisting conditions — while also providing choice.

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