North Dakota Sen. Heidi Heitkamp (D) claimed in a recent ad that her 2018 Senate campaign opponent, Rep. Kevin Cramer (R), allowed health insurance companies to deny coverage to 300,000 North Dakotans with pre-existing conditions.
Fortunately for Cramer — the state's at-large congressman whom President Donald Trump personally tapped to challenge Heitkamp for her seat — Heitkamp's claims don't hold water when weighed with facts.
What did Heitkamp claim?
The first-term senator allowed a constituent, Denise, to make the attack for her. However, the point of the ad is clear: Cramer voted to deny health insurance to thousands of vulnerable North Dakotans, something Heitkamp would never do.
"This is Denise. She lives in Killdeer. Like 300,000 North Dakotans, Denise has a pre-existing condition that used to mean no health insurance. For me, it's breast cancer. For Denise, it's heart disease. She has something she'd like to say to Kevin Cramer," Heitkamp says in the ad.
Denise explains: "Mr. Cramer, I don't know why you voted to let insurance companies go back to denying coverage for pre-existing conditions. But I know Heidi would never do that."
The bottom of the ad cites the Cramer votes in question, from 2013 and 2016. Several times in those two years, Cramer supported GOP-led efforts in the House to repeal Obamacare or defund the controversial law. However, none of those efforts succeeded.
It wasn't until 2017, when Republicans controlled Congress and the White House, that a GOP-led effort to dismantle Obamacare succeeded.
What are the facts?
Both The Associated Press and left-leaning PolitiFact fact-checked Heitkamp's ad, concluding it was heavy on ad hominem and light on fact, although PolitiFact still threw Heitkamp a bone.
The AP reported that Heitkamp is almost correct on the number of North Dakotans with pre-existing conditions. The state estimates 275,000. However, she overstated the number of constituents who would be unable to get health insurance if Obamacare is repealed.
In fact, the number of North Dakotans who would be at-risk of losing coverage due to pre-existing conditions if Obamacare is repealed is much smaller than the figure Heitkamp cited. That's because the majority of those with pre-existing conditions are insured by their employer or the government, therefore not vulnerable to developments in the individual private health care market.
The AP explains:
North Dakota has about 755,000 residents. State Insurance Department figures from 2017 show more than 415,000 have employer health plans that cover people with pre-existing conditions. Almost 220,000 more were covered by government programs such as Medicare and Medicaid, which both now and before the ACA did not make preexisting conditions a barrier to coverage.
That leaves about 60,000 who were on private insurance — and that’s the group that, before the ACA, was most at risk of being denied coverage if they had a pre-existing condition. The state had an additional 60,000 people who don’t have health insurance, but it’s unclear how many in that group have a pre-existing condition.
On the other hand, PolitiFact ruled Heitkamp's claims "half true," mostly on the grounds that Cramer's votes to dismantle Obamacare would jeopardize coverage for individuals with pre-existing conditions in the private health care sector.
Still, PolitiFact conceded that "Cramer's votes technically included provisions to prevent health care companies from denying coverage to people with pre-existing conditions" and "only about a tenth of the 300,000 people in the ad would be directly affected by the laws" Cramer supported.
How did Heitkamp respond?
She told the AP: "In no way did I ever say half the people in North Dakota weren’t covered by health insurance."
Rather through a "clarification," Heitkamp said she meant to emphasize that 300,000 North Dakotans would be at-risk of losing health insurance if Obamacare's pre-existing condition provision is repealed. However, the AP did not note that Heitkamp's claim, which they had just debunked, was false.
Heitkamp's campaign was more coy, telling the AP that the purpose of the ad was to simply highlight the devastating effects many North Dakotans would experience if Obamacare were repealed.
Despite the fact that claims in Heitkamp's ad are downright false, her campaign doubled down on the claims in a recent email blast to supporters.
"Without affordable health insurance coverage for pre-existing conditions, over 300,000 North Dakotans like Karalee, Annelise, Chris, and Sam could lose access to affordable health care or see their premiums skyrocket," the email claimed.