Mandated insurance coverage for pre-existing health conditions has evolved into a central — and disputed — theme in the battle for the governor’s office between Republican Mike DeWine and Democrat Richard Cordray.

Claims and counterclaims over DeWine’s position are dominating TV ads leading up to the Nov. 6 election, including a new one Wednesday featuring the attorney general’s daughter, Anna, saying her father’s caring heart is “why he supports health-care coverage for people with pre-existing conditions.”

Cordray considers health care "the No. 1 issue on the minds of Ohioans" and presses every opportunity to call out DeWine over what he calls "an election-year conversion" on pre-existing-condition coverage.

While he filed suit in 2011 to overturn Obamacare — including its guarantee of coverage for pre-existing conditions and provision for Medicaid expansion — DeWine now says he “always” has supported prohibiting insurers from cherry-picking more-profitable, healthy customers while denying coverage to millions of Ohioans with chronic conditions.

"I have fought for that and I will continue to do that," DeWine said during Monday's gubernatorial debate in Marietta.

Cordray, who narrowly lost the attorney general’s office to DeWine in 2010, consistently has supported the politically popular component of the Affordable Care Act, which attracted a TV commercial attack from DeWine eight years ago.

At an event Wednesday featuring a 750-member group dubbed "Doctors for Cordray," the Democrat ridiculed DeWine’s support for pre-existing coverage as one of political convenience in order to side with a majority of voters. A recent Kaiser Family Foundation poll found 75 percent of those surveyed consider the coverage guarantee "very important."

“For eight years he has had the power of the state at his disposal. What has he done in the past eight years to protect pre-existing conditions?” Cordray asked. “When he says what he is for, contrast it with the record of what he has done.”

Asked what actions DeWine has taken as attorney general to preserve insurance coverage for chronic conditions, DeWine campaign spokesman Joshua Eck would not list anything.

But the DeWine campaign points to seven votes cast by the Republican between 1989 and 2006 while he served in the U.S. House of Representatives and the U.S. Senate as evidence of his longtime support of coverage for pre-existing health conditions. Some of the bills mandated coverage through "high-risk" state health-insurance pools for the uninsured with health problems.

The attorney general’s office and the campaign now stress that when DeWine joined a lawsuit by Republican attorneys general in 2011 to throw out Obamacare, his objection centered on the individual mandate imposing a tax fine on those who failed to obtain insurance despite sufficient income. But the campaign has not provided documentation of him saying at the time that he still supported the portion of Obamacare on pre-existing conditions. His campaign pointed out Thursday that during a 2012 radio show, DeWine called coverage for pre-existing conditions a "very laudable thing" and hoped Congress would address the issue in a follow-up bill if Obamacare was declared unconstitutional.

The lawsuit failed, and the GOP's federal tax reform last year killed the individual mandate beginning next year.

If that lawsuit had compromised coverage for chronic health problems, attorney general spokesman Dan Tierney said Wednesday, the still-valid Health Insurance Portability and Accountability Act of 1996, for which DeWine voted in the Senate, would have required coverage for most pre-existing conditions. However, there are several coverage gaps and exclusions in the law that could leave some people without immediate coverage.

DeWine has opted to not join a Democratic bid to defend the Affordable Care Act in federal court in Texas because in addition to seeking to preserve pre-existing coverage, it seeks to revive the individual mandate and its tax fines for failing to obtain insurance, which DeWine considers unconstitutional, Tierney said.

Cordray contends DeWine fought to overturn Obamacare and pre-existing-ondition coverage because donors such as insurance companies and drug companies opposed the measure, a charge denied by the DeWine campaign.

"Whatever position he took years ago is really not relevant," Cordray said. "He has been fighting to take it away and not fighting to protect it. Now that we are in the middle of an election fight, suddenly he wants to clean up his record."

The candidates also have swapped charges over Republican Gov. John Kasich's expansion of Medicaid, the state-federal health-care program for the poor, to more than 600,000 Ohioans, mostly low-income workers. DeWine declared it financially unsustainable and lambasted GOP primary opponent Lt. Gov. Mary Taylor over the expansion — before announcing after the primary that he supported keeping the expansion as the Ohio State Medical Association political action committee endorsed his candidacy. It cited his support for the Medicaid expansion.

rludlow@dispatch.com

@RandyLudlow