WASHINGTON — In advertisements, in debates and on the campaign trail, Republican candidates are abandoning their promise to “repeal and replace” the Affordable Care Act and are swearing that they never voted to undo protections for people with pre-existing medical conditions — and never will.
But as the candidates seek to assuage voters who say health care is their top issue, their leaders are staying the course, setting up a collision between campaign promises and the party’s agenda should Republicans emerge from the midterms in control of Congress.
Representative Steve Scalise, the House majority whip and possible speaker, vowed to revisit the legislation to replace the Affordable Care Act that passed the House last year but died in the Senate. “As long as we can keep making it better we will,” he said in an interview, “but ultimately we need to fix this broken system.”
That is not the message voters are hearing. Some of the campaign claims have been audacious — Senator Ted Cruz of Texas, in a debate this week with his Democratic rival, Representative Beto O’Rourke, said he had never taken aim at pre-existing conditions, even though the “Cruz amendment,” offered during the Senate debate to repeal the Affordable Care Act, expressly permitted insurance companies to offer plans with none of the protections of President Barack Obama’s signature domestic achievement, including those for pre-existing conditions.
In the House, dozens of lawmakers who voted repeatedly to repeal the Affordable Care Act have introduced or signed onto resolutions affirming the importance of coverage for those with pre-existing conditions, even though such protections would have been weakened or removed by their votes.
Some, like Representative Dana Rohrabacher, Republican of California, have released ads explaining their support for the issue, and others have scrubbed critical mentions of the Affordable Care Act from their websites entirely.
“They’re just trying right now to hold the House, and then they’re going to reassess where they are on the issue,” said Tim Chapman, the executive director of Heritage Action, a conservative lobbying group.
If the language on the campaign trail is to be believed, that reassessment could be dramatic. Representative John J. Faso, Republican of New York, voted last year to repeal the Affordable Care Act on a razor-thin, party-line vote. Now in the political fight of his life, Mr. Faso said he hoped Congress would take a more bipartisan approach.
“The thing I think would be most important would be to actually get buy-in from a certain number of Democrats,” he said, adding, “If we try to go down a one-party approach, I think that’s doomed to failure.”
Republicans are betting that voters will distinguish their attempts to repeal the Affordable Care Act from the issue of pre-existing conditions. They maintain that their replacement bill, the American Health Care Act, would ensure that people with pre-existing conditions could receive insurance, although the bill would have let states seek waivers that would weaken those protections. It would have also eliminated rules blocking insurance companies from charging patients with pre-existing conditions more.
But political winds have shifted. A Fox News poll released this week found that 54 percent of those polled had a favorable opinion of the Affordable Care Act, tying a record high.
Health care remains voters’ top issue in the midterms, according to polling released Thursday by the nonpartisan Kaiser Family Foundation. When those who call it very important are asked to describe what health care issue concerns them, nearly one in five names a need to increase access, and far fewer mention opposition to the Affordable Care Act, the poll found. Those findings track with a previous study that found widespread support for the health law’s provision preventing insurance companies from denying coverage based on a person’s medical history.
“This seems to be a real breakthrough for people; whatever else they understand about how health insurance works, it bothers them to think that insurers might charge you more or exclude coverage for your condition because it’s pre-existing,” said Karen Pollitz, a senior fellow at the foundation. “It registers in such a profound way with the public, they want that to continue to be the law of the land.”
But Republican leaders have not wavered. Senator Mitch McConnell of Kentucky, the majority leader, told Bloomberg News this week, “It’s no secret that we preferred to start over” to repeal and replace the health law.
Democrats have seized on Mr. McConnell’s remarks as proof that Republican candidates’ tempered remarks are nothing but campaign artifice.
“Republican candidates know they are on the losing side of this issue, so they’re just covering their tracks,” said Leslie Dach, the chairman of Protect Our Care, a liberal advocacy group. “They’re putting these statements on TV, and I think McConnell’s statement pulls the rug out from everything they’ve been saying.”
Representative Nancy Pelosi of California, the Democratic leader, accused Mr. McConnell of “blurting out the truth.”
“If the G.O.P. controls Congress next year, they will return to their monstrous campaign to steal health insurance from tens of millions of families, raise health costs, impose an age tax on older Americans and destroy protections for the 130 million people with pre-existing conditions,” she said.
Republicans, in turn, have accused Democrats of misrepresenting their position on health care, dismissing their attacks as fear tactics.
“They’re trying to bait and switch you, so Republicans appear to be on the defensive,” said Representative Pete Sessions, Republican of Texas. “They are going to use this desperate lie of an attack against us when in fact what we’re trying to do is cater” to constituents.
But on the campaign trail, the advertisements appear to have at least tempered how candidates previously supportive of repealing the legislation are willing to discuss the issue.
Mr. Faso counts himself among more than a dozen Republicans who signed onto a resolution “expressing the sense of the House of Representatives that a replacement for the Patient Protection and Affordable Care Act should have certain features” introduced by Mr. Sessions, affirming the importance of ensuring protections for those with pre-existing conditions.
“I felt strongly I needed to reiterate my position on it. I just think the principles that are outlined are ones that could help guide us going forward,” Mr. Faso said.
Whether that approach carries into the next legislative session remains to be seen. But Karlyn Bowman, a senior fellow at the conservative American Enterprise Institute who studies American public opinion, noted the power of the public as a balance to governing authority.
“What candidates are hearing on the local level now is that people are really concerned that perhaps some of the protections in Obamacare will be taken away,” Ms. Bowman said.
If re-elected, will Republicans weigh those concerns when they consider further action?
“I think they will have to,” she said.