Preexisting conditions — a cudgel Democrats are using to batter Republicans in the 2020 campaigns

Democrats running for Congress this year have differing views on how to expand health care coverage, but they’ve been united in attacking Republicans on the issue of preexisting conditions, according to a PolitiFact review.

Claims that Republicans will weaken or destroy protections for people with preexisting health conditions have been made in all 18 of the pivotal congressional contests that PolitiFact is tracking.

Some of the attacks appear in ads or statements issued by the Democratic candidates, while others come from the Democratic Congressional Campaign Committee, which works to elect Democrats to the House. 

The protections for people with preexisting conditions are a pillar of the Affordable Care Act, which faces a November challenge in the Supreme Court that’s backed by Republicans and the Trump administration. 

DCCC spokesman Cole Leiter said the issue is as important as it was in the 2018 elections, when Democrats picked up a net of 40 seats in the House. He said a survey done Sept. 26 and 27 for the committee showed 70% of voters in 57 battleground House districts want the Supreme Court to protect provisions that bar insurers from discriminating against people with preexisting conditions.

"Everybody either has a preexisting condition or knows someone  who has a preexisting condition," Leiter said. "The fact that Republicans in Washington are trying to undermine something so basic, it’s unconscionable to folks."

Leiter’s GOP counterpart did not respond to our requests for comment. President Donald Trump has not presented a Republican-backed health plan despite repeated promises to do so. Republicans in the current Congress have also been unable to come together behind a major plan.

The Affordable Care Act, commonly known as Obamacare, prevents insurance companies from excluding patients with preexisting conditions through multiple provisions.

First, the law says point-blank that carriers "may not impose any preexisting condition exclusion." It backs that up with another section that says they "may not establish rules for eligibility" based on health status, medical condition, claims experience or medical history.

Another provision limits the premiums that can be charged to older policyholders.

Here are examples in each of the 18 tossup races PolitiFact is tracking of attacks related to preexisting conditions (numerals refer to House district numbers): 

Alabama Senate: Doug Jones attacking Tommy Tuberville: Tuberville "wants to eliminate the Affordable Care Act, "ending protections for people" with preexisting conditions.

Arizona 6th District: Hiral Tipirneni attacking David Schweikert: Schweikert voted repeatedly to prevent insurers "from denying coverage or charging more" for preexisting conditions.

Arizona Senate: Mark Kelly attacking Martha McSally: McSally voted "five times to dismantle or undermine protections for people with preexisting conditions."

California 25th District: DCCC attacking Mike Garcia: Garcia voted to support repealing the Affordable Care Act, "which protects people with preexisting conditions."

Florida 26th District: DCCC attacking Carlos Gimenez: Gimenez "stands with Trump on the President’s plan to gut protections for preexisting conditions."

Georgia 6th District: Lucy McBath attacking Karen Handel: Handel supports "eliminating coverage for those with preexisting conditions."

Georgia Senate: Raphael Warnock attacking Doug Collins, Kelly Loeffler: Collins and Loeffler want to repeal the Affordable Care Act, "gutting protections" for preexisting conditions.

Maine 2nd District: DCCC attacking Dale Crafts: Crafts "supported repealing the Affordable Care Act, gutting protections for preexisting conditions."

Maine Senate: Maine Democratic Party attacking Susan Collins: Collins "voted to eliminate preexisting conditions protections with her vote for the GOP tax bill."

Michigan Senate: AFSCME attacking John James: James "wants to allow insurance companies to discriminate against people with preexisting conditions."

Missouri 2nd District: Jill Schupp attacking Ann Wagner: Wagner "voted five times against protecting preexisting conditions."

Montana Senate: Steve Bullock attacking Steve Daines: Daines "voted to let insurance companies deny you coverage for preexisting conditions."

New York 2nd District: DCCC attacking Andrew Garbarino: Garbarino has voted "against protecting New Yorkers with preexisting conditions."

Pennsylvania 8th District: DCCC attacking Jim Bognet: Bognet will support "stripping protections for preexisting conditions."

Pennsylvania 10th District: Eugene DePasquale attacking Scott Perry: Perry "voted to take away those protections for people with preexisting conditions."

South Carolina 1st District: DCCC attacking Nancy Mace: Mace "has promised to derail health laws that protect people with preexisting conditions."

Texas 22nd District: DCCC attacking Troy Nehls: Nehls "would be a rubber stamp" to "strip away coverage from Texans with preexisting conditions."

Virginia 7th District: DCCC attacking Nick Freitas: Freitas "supports a plan letting insurance companies deny coverage for preexisting conditions."

Some of the claims against Republicans are valid, and some aren’t.

In Virginia, the Democratic TV ad claimed that Republican Nick Freitas, who is challenging Democratic Rep. Abigail Spanberger, "supports a plan letting insurance companies deny coverage for preexisting conditions like asthma or diabetes." We rated the claim True. 

Freitas, a member of the Virginia House of Delegates, has voted for extended short-term health insurance plans, which can legally deny coverage based on preexisting conditions. And he has repeatedly called for abolishing the Affordable Care Act.

But in the Michigan Senate race, the AFSCME public employees union claimed in a TV ad that Republican John James "wants to allow insurance companies to discriminate against people with preexisting conditions." Our rating was Mostly False.

James, a businessman and combat veteran, is challenging Democratic incumbent Gary Peters. James supports making changes to the Affordable Care Act, but he says he wants to cover and protect people with preexisting conditions.

Some Republicans have campaigned on claims they will protect insurance coverage for people with preexisting conditions. 

But those who have cited their support of a 2017 GOP alternative to Obamacare, the American Health Care Act, have run into problems because the proposal didn’t actually offer robust protection. 

Sen. Martha McSally, R-Ariz., cited the bill and earned a False from us for claiming: "Of course I will always protect those with preexisting conditions. Always." Experts said the GOP alternative would effectively weaken the protections contained in Obamacare, experts said.

On Oct. 1, six GOP senators — including McSally and Susan Collins of Maine, both of whom are facing tough re-election races this fall — voted with Democrats for a procedural motion to debate a bill to stop the Department of Justice from advocating in court to strike down the Affordable Care Act. The vote needed 60 votes for passage but failed, 51-43.

Meanwhile, Democratic House candidates including California’s Christy Smith, Pennsylvania’s Matt Cartwright and New York’s Jackie Gordon have campaigned citing their support of Obamacare, or bills they say would provide even more protection for preexisting conditions. 

"I’ve always protected people with preexisting conditions," former Montana Gov. Steve Bullock, who is running for the Senate, declares in a TV ad.

CORRECTION, Oct. 6: An earlier version of this story incorrectly described the Oct. 1 votes by GOP senators including Martha McSally and Susan Collins on a bill related to the Affordable Care Act.