President Donald Trump wants voters to believe that Republicans are the party protecting Americans with preexisting conditions. But in bills, lawsuits, and regulations, they’ve worked to do the very opposite.

Trump’s own administration imposed new rules just last week that would make it easier for insurance providers to discriminate against sick consumers.

On the same day news broke about the change, Trump didn’t even blink as he told an audience he held the exact opposite view. “We will always protect Americans with preexisting conditions,” he said at an event in Philadelphia earlier this month.

Republican candidates have followed Trump’s lead. Missouri Senate candidate Josh Hawley is telling voters that he supports “forcing insurance companies to cover all preexisting conditions.”

But here’s the thing: It isn’t true. Republicans are lying about their position on preexisting conditions, and voters have a right to know that.

Coverage for preexisting conditions matters to Americans. The Kaiser Family Foundation has found that it is the most important health care issue in this election. For 14 percent of Americans, it is the “single most important” factor in their vote.

We know Republicans do not support forcing insurance providers to cover patients with preexisting conditions because they spent most of 2017 trying to roll back that part of Obamacare.

We know Trump definitely does not want to uphold regulations on preexisting conditions because his administration has asked a federal court in Texas to throw those protections out.

Republicans aren’t telling the truth about their position because their actual position, it turns out, isn’t very popular. Americans like the idea of making sure sick people have access to health insurance.

With just over a week left until the midterm elections, Americans deserve to know the truth: Republicans support policies that would make it harder to for sick people to get health insurance.

Trump’s position on preexisting conditions, explained

There are some policy debates where it’s difficult to figure out where different candidates stand. For example, I don’t know what every candidate really means when they say they support “Medicare-for-All.” The term is shorthand for a universal coverage system, but what that system looks like exactly can vary.

The debate over preexisting conditions isn’t like that. It is a debate where we have lots and lots of evidence of where Trump and others stand.

Trump has repeatedly supported legislation, regulations, and lawsuits to make it harder for sick people to get health insurance.

Most obviously, he backed Republican efforts to repeal the Affordable Care Act, replacing it with the American Health Care Act. That bill would have reopened the door for insurers to charge sick people higher premiums — and to stop covering the health law’s essential health benefits, a requirement in Obamacare that made sure more insurance plans covered more of the basics.

Less publicly, the Trump administration has pushed forward regulations that will drive up premiums for sicker Americans. He has widened the availability of skimpy “short-term” plans that are allowed to not cover prescription drugs, maternity benefits, or people with preexisting conditions.

But perhaps Trump’s most brazen move is supporting a lawsuit that would eliminate Obamacare’s preexisting condition protections completely. The Trump administration has filed a brief in federal court arguing that these protections are unconstitutional and ought to be thrown out completely.

Let that sink in for just a moment. President Trump is tweeting things like, “All Republicans support people with preexisting conditions.” But that is just not the position of his White House, full stop. If the federal court sides with the Trump administration, protections for Americans with preexisting conditions would cease to exist.

The world that President Trump has pushed for — in federal regulations, in congressional legislation, in legal filings — is undeniably a world where it is harder for the Americans who need health insurance to get access to it.

Republican candidates aren’t telling the truth on preexisting conditions

The landscape, unfortunately, looks similar when you look at the claims of Republican congressional candidates.

Take, for example, Hawley, the Missouri Senate candidate. He has run an ad with the following script:

We’ve got two perfect little boys. Just ask their mama. Earlier this year, we learned our oldest has a rare chronic disease. Preexisting condition. We know what that’s like. I’m Josh Hawley. I support forcing insurance companies to cover all preexisting conditions. And Claire McCaskill knows it. You deserve a senator who’s driven to fix this mess, not one who’s just trying to hang onto her office. And that’s why I approved this message.

Here’s the thing Hawley’s ad doesn’t say: He is also party to the lawsuit aiming to overturn Obamacare’s preexisting condition protections. He is among 20 conservative attorneys general who brought that case to a federal court in Texas, the one the Trump administration has signed onto.

Hawley and the 19 other attorneys general could drop off that lawsuit at any moment. They could decide the threat to preexisting conditions is just too great. But nothing like that has happened. Instead, as Sam Stein at the Daily Beast notes, “no Republican candidates have explicitly dropped their support for that same lawsuit or disavowed it either.”

We have seen one effort on Capitol Hill to do damage control around this lawsuit. Ten Republican senators introduced a bill that would require insurers to cover Americans with preexisting conditions.

This sounds great — until you learn about one gigantic loophole: The insurance policy wouldn’t have to cover the preexisting condition itself. In other words: An insurer would have to offer a health insurance plan to a cancer patient, but that health plan could exclude her cancer treatment. This, as the end of the day, isn’t much protection for preexisting conditions at all.

The promises that candidates make on health care matter

I saw this firsthand two years ago, when I went to Kentucky to write a story about Obamacare enrollees who voted for Trump. I asked a lot of voters: Why did you support the candidate who campaigned on getting rid of your health insurance?

I heard the same answer again and again: He promised that something better would come along. The voters I met during that reporting trip had paid attention to the election. They knew that Trump wanted to repeal Obamacare. But they also listened to the promises that came after that — his repeated claims that he would come up with something better to replace it.

Americans are listening to the claims candidates make about health care. They are hearing Republicans claim that they want to protect preexisting conditions. And in some cases, they are probably believing those claims. Mostly because we don’t expect our representatives to lie so brazenly to us.

But everything I’ve seen covering the Obamacare repeal debate — from the bills on Capitol Hill to this new anti-ACA lawsuit — tells me that Republicans are not interested in protecting preexisting conditions. And voters should know that before casting their ballots.

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