Many Republicans running for election are quick to tell voters that they support health insurance protections for people with pre-existing conditions, but they often are mum about whether they also support policies that ensure that such protections are meaningful or affordable.
Several Republican campaigns in tough races for Senate surveyed by the Washington Examiner would not say whether they support essential health benefits, a protection that ensures that people with pre-existing conditions get their specific treatments covered, or community rating, a protection that ensures plans are not too expensive.
For instance, Leah Vukmir, a Republican running to unseat incumbent Democratic Sen. Tammy Baldwin in Wisconsin, supports coverage for pre-existing conditions, campaign spokesman Jahan Wilcox said.
But when asked to elaborate on whether Vukmir supports essential health benefits and community rating, Wilcox told the Washington Examiner that he wouldn’t get into “the weeds.”
Vukmir, like many other Republican candidates, has faced Democratic attacks that she does not actually support coverage for patients with pre-existing conditions.
It's been a winning issue for Democrats: Polls show that healthcare is at the top of voters' minds, and protections for sick or hurt people are popular. Sensitive to the risk his party faces, President Trump has sought to convince voters that the GOP favors pre-existing condition protections. He tweeted on Thursday that “all Republicans” support pre-existing condition protections, and that he would 'speak to' ones that don't.
One healthcare expert said that Republicans likely don’t want to talk about the details of covering pre-existing conditions because doing so dredges up last year's unpopular Obamacare repeal effort.
“Both the House-passed ACA repeal bill and last fall’s Graham-Cassidy proposal [in the Senate] would have made it much more expensive or, in some cases, impossible for people with pre-existing conditions to obtain coverage,” said Matthew Fiedler, fellow with the Center for Health Policy at the Brookings Institution, a think tank.
Since a large majority of Republicans supported one of those bills, “it is easy to see why many members might want to avoid the topic,” he added.
Essential health benefits require Obamacare insurers to cover 10 benefits, including maternity care, mental healthcare, and hospitalization. Community rating requires insurers to charge the same rate for everyone in a geographic area, the goal being that an insurer cannot charge a person with a pre-existing condition more than a healthy person in the same area.
Both those policies complement Obamacare's requirement that insurers not deny coverage for people with pre-existing conditions. All three protections apply to plans sold on Obamacare’s insurance exchanges, which are meant to help people who don't get coverage through work or from the government.
Republicans in tight races are not citing support for the interlocking policies, even though they say they support the pre-existing condition protection the other two provisions are meant to support.
Other Republicans declined to say if they support essential health benefits and community rating.
For example, a spokesman for Mike Braun, a businessman running against Sen. Joe Donnelly, D-Ind., said that Braun "believes plans that actually work for Hoosiers will come from market-driven solutions, not more of what big government and the insurance industry force upon them."
Braun also has touted the healthcare coverage he has provided to his employees as evidence he will protect people with pre-existing conditions. Under federal law, he was required to do so.
Sen. Dean Heller, R-Nev., the most vulnerable GOP incumbent, has also been under fire for his support of Obamacare repeal in the Senate.
His campaign responded to the question of whether he supports the policies by noting that Heller “has co-authored two pieces of legislation that preserve protections for Nevadans with pre-existing conditions.”
One of the bills in question would codify protections for pre-existing conditions for people in the individual market.
But several healthcare analysts have found the legislation to be lacking because it doesn’t ensure the coverage of essential health benefits. Insurers would be required to cover people with pre-existing conditions, but not their treatments.
"It would allow insurers to exclude any coverage of the pre-existing conditions. A bit of a catch," tweeted Larry Levitt, senior vice president of the research firm Kaiser Family Foundation, after the bill was released.
A new bill would require insurers to guarantee access for people with pre-existing conditions and prohibit premiums based on health. But, it would allow insurers to exclude any coverage of the pre-existing conditions. A bit of a catch.https://t.co/Dgc1DNor0B— Larry Levitt (@larry_levitt) August 24, 2018
The campaign for Rep. Kevin Cramer, R-N.D., on the other hand, did say that he believes “insurers must cover individuals regardless of health status and that they should not be able to charge higher premiums because of an illness if individuals maintain continuous coverage.”
Cramer is challenging Sen. Heidi Heitkamp. D-N.D.
His campaign said that states should get waivers from the federal government to establish “new benefit standards.”
“Current law prohibiting pricing customers based on health status should remain in place and could only be waived by a state if that state had chosen to take care of the people through other risk-sharing or reinsurance mechanisms,” the campaign said.
The proposal is modeled after a controversial amendment to the House GOP repeal bill authored by Rep. Tom MacArthur, R-N.J., who himself is facing a tough re-election campaign.
The amendment would have created the possibility that states could drop essential health benefits and community rating for people in the individual market, meaning that people in those states could lose the protections if they switched healthcare plans or lost coverage.
While the amendment helped get Obamacare repeal out of the House, it laid the foundation for a firestorm of Democratic allegations that Republicans were going to repeal pre-existing conditions.
The nonpartisan legislative scorekeeper Congressional Budget Office said that the bill would make it harder for people with pre-existing conditions to get affordable coverage if they lived in waiver states.
Republican candidates also haven't addressed what they would do if a GOP lawsuit that would end Obamacare is successful.
Texas and 19 other states are suing to eliminate all of Obamacare, arguing that it is unconstitutional without the individual mandate’s financial penalty that is repealed started in 2019.
Missouri Attorney General Josh Hawley and West Virginia Attorney General Patrick Morrisey both joined the lawsuit. Hawley is challenging Sen. Claire McCaskill, D-Mo., and Morrisey is going up against Sen. Joe Manchin, D-W.Va.
Both have said that they support coverage for pre-existing conditions, but neither has offered a plan to ensure that coverage if the lawsuit is successful.
Neither Hawley nor Morrisey returned a request for comment for this story.
The Justice Department supports the lawsuit and declined to defend Obamacare in court. DOJ said the court shouldn’t get rid of the entire law, just the protections for pre-existing conditions.