At the center of many Texas congressional battles: Who will protect preexisting conditions rules?

In an ad for her bid for the U.S. House, former Irving Mayor Beth Van Duyne tells the story about how her daughter needed nine surgeries in her first year. Van Duyne, a Republican, says her insurance company denied coverage for her daughter “on her most invasive surgery.”

“But there was no way I was going to let my daughter down, so I fought them and won,” she says in the spot, adding that she knows how important it is to provide protections for people with preexisting conditions.

It’s a message that congressional candidates in both parties are pushing hard in the final days of the 2020 elections. Many Republicans, including Van Duyne, are stressing that they want to preserve protections for preexisting conditions, despite the party’s long-held goal to “repeal and replace” the Affordable Care Act, which mandates that people with preexisting conditions can’t be denied or charged more for insurance.

Democrats, meanwhile, are calling that claim disingenuous given the Republican Party’s longtime opposition to the 2010 health care law. They argue that Republicans have spent the last 10 years trying to take those protections away.

“Ask every single one of them where they stand on [Republican Texas Attorney General] Ken Paxton’s lawsuit to repeal the ACA,” Abhi Rahman, communications director for Texas Democrats, said. “It’s frankly disgusting that they say they’re going to protect preexisting conditions when they want to repeal the Affordable Care Act without a plan to replace it. It fires me up because these people are lying to the people of Texas.”

Van Duyne’s opponent in the North Texas district, Democrat Candace Valanzuela, says she wants to expand the Affordable Care Act and has also emphasized protections for those with preexisting conditions — she suffers from chronic back pain after a car accident.

The issue has taken on even more salience during the coronavirus pandemic. Texas already had the highest rate and largest number of people without health insurance in the U.S. and the pandemic increased that rate — as of May, 29% of Texans under the age of 65 were uninsured. It has also sprouted worries that having had the virus would be a preexisting condition if protections were eliminated.

In 2017, a Republican-controlled Congress attempted to “repeal and replace” the Affordable Care Act — a promise Republicans ran on during the 2016 election. However, it became clear that none of the proposals would garner enough votes to pass. Democrats then ran on the issue during the 2018 midterm elections, defending the Affordable Care Act. They flipped the House, gaining a net total of 41 seats.

Now Republicans and the Trump administration’s best hope of eliminating the law is in the courts. Paxton, the Texas attorney general, sued the federal government in 2018 seeking to overturn the individual mandate portion of the Affordable Care Act, which sought to penalize those who choose to remain uninsured but was zeroed out in a Republican tax bill. The lawsuit will be heard by the Supreme Court on Nov. 10, and Paxton’s office is arguing that the whole law should be repealed if the individual mandate portion is overturned.

Texas Democrats are emphasizing those efforts to fight the law in their ads and their platforms, warning that voters may find their health care in limbo if the Affordable Care Act is struck down by an increasingly conservative Supreme Court.

But GOP candidates are seeking to undercut those attacks, saying that it’s other parts of the law they oppose and that they’d seek to protect preexisting condition rules.

Making that case is easier for Van Duyne, who has never served in Congress. Her campaign didn’t respond to a question how she would prefer to protect preexisting conditions. However, some more well-known Republicans have been parts of years-long fights to repeal the health care law.

U.S. Sen. John Cornyn, R-Texas, was Senate majority whip in 2017 when Republicans wanted to repeal the law. But in a recent ad, he emphasized his support for the protection of those with preexisting conditions, saying that it “is something we all agree should be covered.” He also touted a bill he cosponsored, the 2019 Protect Act, which he says will safeguard people with preexisting conditions from being charged more by insurance companies. However, experts have said that legislation does not go as far as Obamacare in ensuring those protections.

His opponent, Democrat MJ Hegar, is highlighting the issue and Cornyn’s record. After Cornyn joked that it was “ACA vs. ACB” during Amy Coney Barrett’s confirmation hearing, Hegar’s campaign pounced.

“Your little line isn’t cute, John, it’s potentially deadly for 5 million Texans with pre-existing conditions,” Hegar tweeted.

Cornyn has not clearly stated whether or not he supports the Texas-led challenge against the Affordable Care Act. He has said he wants the “Constitution to be enforced.”

The issue of preexisting conditions has also come up in the race for U.S. Rep. Will Hurd’s seat in West Texas — one of the “most medically underserved districts in the country,” according to Democrat Gina Ortiz Jones.

Throughout her campaign, Jones has attacked Republican Tony Gonzales for supporting the elimination of the Affordable Care Act, and as a result, the protections of people with preexisting conditions. Gonzales said he does support the elimination of Obamacare but pledged to support those with preexisting conditions, often reminding voters that he has one himself — he went into a coma for three days and suffered brain trauma and kidney failure after being incorrectly intubated.

"It's not an easy fix. It takes folks to come together and come up with a solution to it. It's not a one size fits all," Gonzales said in an interview with The Texas Tribune. "In District 23, the Affordable Care Act does not work right, so we need to come up with a replacement to that. I look forward to getting on the Hill and working toward a replacement that covers preexisting conditions."

U.S. Rep. Dan Crenshaw, R-Houston, recently fought with former congressman Beto O’Rourke on Twitter after O’Rourke tweeted that Crenshaw was a “gaslighting Texas Trump puppet” for trying to reduce access to health care.

Crenshaw, while admitting that he does want to eliminate Obamacare, said he has supported amendments to Democratic legislation to address preexisting conditions such as H.R. 692, which would preserve health care for people with preexisting conditions if the Affordable Care Act was changed or repealed.

Straying from the crowd, U.S. Rep. Chip Roy, R-Austin, has kept to the message of leaving the government out of health care in his race against Democrat Wendy Davis. He said the current health care system “created the preexisting condition issue” and plans to increase individual access to health care by centering it “on personal control carried out through expansive personal health-care savings supplemented by individuals, employers, and even charitable third parties.”

But Roy has picked up on a common attack Republicans are using against their opponents: highlighting the popularity of an expensive “Medicare for All” proposal among many Democratic voters. Davis has not called for Medicare for All, but does support a government-run “public option” health insurance alternative.

“I’m glad my opponent just mentioned her support of a public option which is pretty much the JV path to Medicare-for-All and the problem with that is it would lead us to a $25 trillion system that we cannot afford,” Roy said in a debate against Davis. “This is the system of a government solution which causes rationing and increases pricing rather than putting you in control of your healthcare.”

Texans are still split on the issue of health care, with Republican voters being less concerned about the issue. And a majority of Texans aren’t sold on the idea of universal health care — a February University of Texas/Texas Tribune poll found that 41% of Texas voters supported it while 46% preferred the current system.