Ahead of the midterm elections, Republicans are positioning themselves as members of the party that will protect people with pre-existing conditions. But this campaign strategy simply doesn’t match up with their voting record on health care.

“Republicans only will always protect patients with pre-existing conditions,” said President Donald Trump during a campaign rally for Rep. Andy Barr (R-KY) over the weekend.

Meanwhile, the truth is Barr voted to weaken protections for people with pre-existing conditions five different times since he started representing Kentucky’s 6th Congressional District in 2013. And he’s hardly alone in voting that way.

Of the 73 Republicans in House races deemed competitive by the Cook Political Report, 67 voted at least once to eliminate Affordable Care Act (ACA) protections for people with pre-existing conditions, according to an analysis from the Center for American Progress Action Fund. Fifty-six Republicans voted more than once to overturn these protections; 31 voted more than six times to overturn these protections; and 24 voted all nine opportunities they had to overturn these protections without replacing them with something comparable.

ThinkProgress is an editorially independent publication housed at the Center for American Progress.

Vulnerable House Republicans are distancing themselves from their anti-Obamacare votes, likely because a majority of the public now supports the current health law — a sea change that came after conservatives introduced their own health bill last year.


Some conservatives are now trying to convince voters they’ll fight for parts of the ACA, running campaign ads that pledge to protect people with pre-existing conditions and introducing toothless measures that say as much. ThinkProgress separately found that at least 36 of the 73 vulnerable House Republicans are doing this. All but four of them voted at least once to eliminate protections for people with pre-existing conditions.

“David stood up to his party to protect Iowans with disabilities and pre-existing conditions,” narrates the voice-over in an ad for the David Young for Congress campaign. Young (R-IA), who’s in a tight race with Democrat Cindy Axne, voted to weaken these protections twice since being first elected to office in 2014. He did introduce a resolution in September stating that Congress should protect people with pre-existing conditions, but it was non-binding and instead a legislative cover for his past votes.

Rep. Pete Sessions (R-TX), who voted to defund or repeal Obamacare nine different times since 2011, also introduced a similar non-binding resolution in October.

Rep. Dave Brat (R-VA) didn’t co-sponsor any of these symbolic measures, but says in a new ad that he’s provided health care to people with pre-exiting conditions. He neglects to mention in the ad that he voted twice to weaken ACA protections without replacing them with similar safeguards.

This revision of history isn’t limited to House Republicans. Incumbent Senate and gubernatorial candidates running in tight races against Democratic challengers are campaigning similarly.


The irony is that for four straight election cycles, the GOP actively campaigned on Obamacare repeal. But now, for the first time in over a decade, many vulnerable Republicans in the House and Senate have retired the “repeal and replace” mantra.

“Somehow the repeal and replace vote allowed this one concept to really break through to people, which is that ‘I buy health insurance in case I get sick, so I don’t want it to treat me badly when I get sick,'” said Karen Pollitz, a Senior Fellow at the Kaiser Family Foundation (KFF).

Six in ten voters say a candidate’s position on continuing protections for people with pre-existing conditions is either the “most important” or “very important,” according to recent KFF polling. These ACA rules garner strong support because a lot of people benefit; more than 52 million people have a pre-existing condition that would have let insurance companies deny them coverage before the ACA.

The ACA isn’t the only way to protect people with pre-existing conditions. Medicare for All is another option and a policy endorsed by some Democratic challengers. But Republicans haven’t been able to propose a solution that lowers premiums and provides quality health coverage.

“The whole repeal and replace effort — and in all the bills certainly that we saw in 2017 — would have left people with fewer protections when they’re sick,” said Pollitz.

“You have to have all the other requirements to make sure insurers will actually take people, actually offer them coverage that will take care of them if they got sick, and because that is not inexpensive, you have to subsidize it. So it really all does fit together and once you start to pick it apart, it doesn’t work very well.”

You can view the full dataset here.

Josh Israel contributed to this report.

CORRECTION: The Center for American Progress Action Fund report mistakenly confused the voting record of Rep. Brian Fitzpatrick (PA-01) for his brother, Mike Fitzpatrick, who represented the same district until 2017. We have updated the numbers accordingly. The Center for American Progress Action Fund also mistakenly identified Rep. Bruce Poliquin (ME-02) as having voted more than once against Obamacare; he only voted for the American Health Care Act.