Republicans Are Running on Health Care for Pre-Existing Conditions. It’s a Lie.

In repeatedly saying they will support policies they have demonstrated they don’t support, the party is degrading a central tenet of democracy.

Nevada Sen. Dean Heller is surrounded by members of the media while on his way to view the details of a new health care bill on July 13, 2017
Nevada Sen. Dean Heller is surrounded by members of the media while on his way to view the details of a new health care bill on July 13, 2017, in Washington. Alex Wong/Getty Images

Congressional Republicans spent much of 2017 trying to repeal the Affordable Care Act. After a failed drive to pass a repeal bill—the American Health Care Act—they successfully voted to end the individual mandate, a key element of the law that helps stabilize health insurance markets. The Trump administration has also tried to undermine Obamacare, loosening rules, reducing outreach, slashing payments to insurers, and throwing insurance markets into chaos. And at the state level, Republican attorneys general have filed suit in an effort to abolish the law in its entirety.

Republicans still want to repeal Obamacare, but they’re telling voters the opposite. On the campaign trail, Republican candidates are stalwart defenders of the Affordable Care Act and its most popular provision: a regulation that prohibits insurers from discriminating on the basis of pre-existing conditions. More than obfuscation or spin, this is outright lying. And as they do it, Republicans are showing contempt for voters, and further fraying our ability to do electoral democracy.

“I support forcing insurance companies to cover all pre-existing conditions,” says Josh Hawley, running for Senate in Missouri, in a television ad defending his record from opponent Sen. Claire McCaskill. And yet, as state attorney general, Hawley joined a lawsuit that, if successful, would wipe out the Affordable Care Act, including its protections for patients with pre-existing conditions. The lawsuit, in fact, specifically argues those provisions have no constitutional basis.

In his final debate with challenger Beto O’Rourke, Texas Sen. Ted Cruz similarly pledged to protect those with pre-existing conditions. “We can protect pre-existing conditions, and you need to understand, everyone agrees we’re going to protect pre-existing conditions.” But Cruz is a front-line fighter in the war against Obamacare and has been for years. In 2013, he shut down the federal government in a drive to defund the law. During the 2016 Republican presidential primary, Cruz outlined his vision for health care with a pledge to “repeal every word of Obamacare,” offering an alternative that made no mention of patients with pre-existing conditions. This summer, when asked the lawsuit that would gut the law and those protections, Cruz defended the suit.

Sen. Dean Heller of Nevada has also cast himself as a defender of protections for patients with pre-existing conditions as he fights a tough re-election race against Rep. Jacky Rosen of the state’s 3rd District. “I’m fighting to protect pre-existing conditions and increase funding for Nevadans who need it most. Jacky, I’ll stack my record up against yours any day,” he says in a recent television ad. But Heller, like Cruz, is an opponent of Obamacare. And while Heller voted against the most far-reaching Republican repeal bill, he backed a measure that would have let states eliminate pre-existing condition protections.

The roster of Republicans defending the Affordable Care Act in their campaigns but not in their actions is long: Wisconsin Gov. Scott Walker, who also joined the lawsuit against the law, has told voters “he will always cover pre-existing conditions, period.” Rep. Dana Rohrabacher of California has said the same—”I’m taking on both parties and fighting for those with pre-existing conditions”—despite voting for a repeal bill that would have let insurers raise prices on those patients. His colleagues Reps. Mike Bishop of Michigan, John Faso of New York, and Martha McSally—running for Senate in Arizona—have all said the same, despite casting their votes against the Affordable Care Act and its provisions. On Thursday afternoon, Donald Trump took the sentiment to its inevitable point of hyperbole, tweeting, “All Republicans support people with pre-existing conditions, and if they don’t, they will after I speak to them. I am in total support. Also, Democrats will destroy your Medicare, and I will keep it healthy and well!”

You can have a well-functioning system of self-governance with politicians who tell half-truths, obscure their motives, and try to evade responsibility for their actions. Indeed, one of James Madison’s great insights was that successful republican government doesn’t require ubiquitous virtue or moral rectitude, since “if men were angels, no government would be necessary” and “if angels were to govern men, neither external nor internal controls on government would be necessary.”

What you do need, however, is a measure of good faith between the public and its representatives. Voters, who take their cues from politicians and political elites, should have some sense of what they’re supporting when they cast a ballot. Barack Obama promised health care reform, and that’s what he delivered; Donald Trump promised a crackdown on nonwhite immigrants, and that’s what he has delivered.

When the Affordable Care Act was unpopular, Republicans promised to repeal it. Now that it’s popular, Republicans are essentially promising to protect it—even as they plan to deliver the opposite if given the chance. “If we had the votes to completely start over, we’d do it,” said Senate Majority Leader Mitch McConnell on Wednesday, floating a second shot at Obamacare repeal. McConnell also called for Medicare and Social Security cuts that, if pursued, would require support from a president who campaigned and won on an explicit promise not to cut the nation’s retirement programs.

If our only measure of political behavior is what works, then lying is just part of the game. But how you win matters. To win with obvious and blatant lies is to corrode political life and degrade the very project of public deliberation. Democracy is more than the sum total of norms, institutions, and procedures. It’s a way of civic life. And with this campaign of deception, the Republican Party is showing its contempt for the public trust which makes that life possible.