A fight over the most popular piece of Obamacare could define the 2018 midterm elections

  • Healthcare was 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 Republicans.
  • 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.

As the 2018 midterm election season comes to a close on Tuesday, so too does a battle over one of the biggest pieces of Obamacare.

Obamacare’s protections for people with preexisting conditions became a heated point of contention for the two parties, with each side arguing that the other was misrepresenting their position on the protections.

Democrats hammered their GOP opponents on the preexisting condition issue, arguing the Republican’s repeated attempts to repeal the Affordable Care Act would have undermined protections for sicker Americans.

The GOP argued that preexisting condition protections have always been a part of their healthcare platform, but also kept the door open for new healthcare policies.

Given the relative importance of healthcare to voters, Democrats ability to highlight the problems with the Republican plans and the GOP’s ability to combat those attacks could determine which party maintains control of Congress.

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 Medicaid.

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 conditions.
  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 recognised 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 replacement:

  • 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 conditions.
  • 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 coverage.

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.

Read more: The midterm elections could decide whether 2.7 million Americans have access to healthcare»

In addition, the Department of Justice declined to defend the ACA in the Texas lawsuit meaning the Trump administration is not trying to fight back against the Texas lawsuit.

The lawsuit has put 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
Sen. Joe Manchin aims a shotgun at a copy of the ACA repeal lawsuit Democrats argue would gut preexisting condition protections in a campaign ad. Joe Manchin/Youtube

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 states.

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 Friday, 58% of Americans say they more trust Democrats to 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.