Josh Hawley, the Republican Senate candidate in Missouri, says he is all about making sure anybody can get health insurance, regardless of their medical status: We need to cover pre-existing conditions, he said earlier this summer .

But Hawley, who is currently Missouris attorney general, is one of the 20 state officials who has signed onto a new lawsuit seeking to eliminate the Affordable Care Acts guarantee of coverage, which they argue is unconstitutional . Hawley is also a longtime supporter of Congress repealing the law outright.

Its simple: Obamacare must go, he told supporters last year.

Hawley would have Missourians believe there is nothing contradictory in his rhetoric and action he simply wants to get rid of Obamacare, not the laws promise of insurance for anybody regardless of pre-existing conditions.

In reality, Hawley and other Republicans have no concrete or well-developed plan for replacing the law with something that would provide the same kind of access. If either the lawsuit he supports or repeal legislation were successful, people with cancer, diabetes and a variety of other chronic conditions would have a much tougher time getting comprehensive coverage. The GOP, including Hawley, is now talking up a Senate bill experts have said wouldnt solve the problem.

Hawley is hardly the only Republican Senate candidate making statements so inconsistent with his record.

Mike Braun in Indiana, Martha McSally in Arizona, Patrick Morrisey in West Virginia, Rick Scott in Florida the list goes on. All across the country, Republicans running for Congress are promising voters they will look out for people with pre-existing conditions while supporting some combination of legislation, litigation and regulation that would undermine those very protections.

Why Pre-Existing Conditions Are Such A Big Deal

Republican candidates are being forced to talk about pre-existing conditions because Democrats keep bringing it up.

You shouldnt have to worry about an attorney general taking away your health care, a Democratic super PAC ad in Missouri says. An ad in North Dakota features a woman with heart disease declaring to GOP Rep. Kevin Cramer: I dont know why you voted to allow insurance companies go back to denying coverage to people with pre-existing conditions. But I know [Democratic Sen. Heidi Heitkamp] would never do that.

One reason Democrats are leaning heavily on this argument is the difficult Senate map before them and the need to find issues, like defending pre-existing conditions, that resonate with independents and even some Republican voters. This year, Democrats are defending seats in 10 states that President Donald Trump carried in 2016, and one of their best opportunities to pick up a new seat is in Arizona, another state that Trump won.

The other reason Democrats are pounding away at the issue is that the stakes are high, with the livelihoods and lives of many Americans depending on the outcome. The ACA rewrote the rules for insurers selling plans directly to individuals and families so that carriers could no longer deny coverage or otherwise discriminate against people with pre-existing conditions.

The transformation came at a cost: Insurers, forced to cover bills they had previously avoided, jacked up premiums in response. And although new tax credits offset the increase for most buyers, they dont help everybody. The resulting backlash helped Republicans to win elections, giving them a chance to repeal the law.

And they havent given up, even though last years effort failed. Just this week, Vice President Mike Pence reaffirmed the partys determination to take up repeal in 2019 if they still control Congress. In the meantime, the Trump administration has been using its executive authority to undermine pre-existing condition protections unilaterally most recently, by effectively creating a parallel market with plans that dont live up to the ACAs standards.

These plans generally arent available to people with pre-existing conditions and dont include many essential benefits, which means people who manage to get them are risking financial ruin if they get seriously ill. And by drawing healthy people out of the broader pool, these new plans will force insurers to jack up rates, forcing people with pre-existing conditions to pay more for coverage.

Thats not the only threat to the ACA right now. Theres also the lawsuit that Hawley, along with officials from 19 other politically conservative states, has co-signed. The plaintiffs argue that, because the 2017 GOP tax cut reduced the ACAs individual mandate penalty to zero, the laws insurance regulations are now unconstitutional. Even many conservative experts think the case relies on an absurd legal argument , but it has support from the Trump administration. Next week, it will go before a conservative federal judge in Fort Worth, Texas.

Morrisey, the West Virginia attorney general who is challenging incumbent Democratic Sen. Joe Manchin, also signed the brief. He supports repeal, as does Scott , who is trying to unseat Democrat Sen. Bill Nelson in Florida and has spent much of his time as governor fighting the law . McSally, who is now running for an open seat in Arizona, was in the House when it took up repeal. She voted yes .

And then there is Matt Rosendale, the Republican candidate who running against two-term incumbent Sen. Jon Tester in Montana. Rosendale is the states insurance commissioner, putting him in a unique position not just to talk about health care policy but also to enact it. Among his notable actions was last years decision to reverse a long-standing prohibition on Christian health sharing ministries which, like the plans Trump just approved, have some combination of exclusions for pre-existing conditions, limits on coverage and big gaps in benefits.

Rosendale, like the others, has been a vocal advocate for Obamacare repeal .

Why Pre-Existing Conditions Are A Tough Issue For Republicans

Protections for people with pre-existing conditions are wildly popular , and Obamacare itself is gaining in the polls. Democrats know this and have been hammering Republican candidates over and over again, especially in the reddest states on the political map. (Trump won the 11 states with the highest percentage of adults with pre-existing conditions by an average of 26 percentage points; five of those states have competitive Senate races in 2018.)

In almost every state with a competitive Senate race, the Democratic candidate or an outside group controlled by allies of Senate Minority Leader Chuck Schumer is airing an ad on pre-existing conditions.

The lawsuit has proven to be a particularly useful foil, because it put the issue of pre-existing conditions into the news at a time when memories of the 2017 repeal fight had started to fade, and because it directly implicates GOP candidates in Missouri and West Virginia.