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Ted Cruz once shut down the government over Obamacare. Now, he vows to defend a key part of the law.

Cruz has repeatedly voted to weaken coverage for people with pre-existing conditions since 2013.

SAN ANTONIO, TX - OCTOBER 15:  U.S. Sen. Ted Cruz (R-TX) debates U.S. Rep. Beto O'Rourke (D-TX) at the KENS 5 studios on October 16, 2018 in San Antonio, Texas. A recent poll show Cruz leading O'Rourke 52-45 percent among likely voters.  (Photo by Tom Reel-Pool/Getty Images)
SAN ANTONIO, TX - OCTOBER 15: U.S. Sen. Ted Cruz (R-TX) debates U.S. Rep. Beto O'Rourke (D-TX) at the KENS 5 studios on October 16, 2018 in San Antonio, Texas. A recent poll show Cruz leading O'Rourke 52-45 percent among likely voters. (Photo by Tom Reel-Pool/Getty Images)

Sen. Ted Cruz (R-TX) — who’s repeatedly voted to repeal the Affordable Care Act (ACA) without a replacement and for the widely unpopular GOP health bill — told voters he wants to protect people with pre-existing conditions.

Cruz repeatedly misled Texans about his record and on Medicare for All during a debate with his Democratic challenger Rep. Beto O’Rourke Tuesday night. With polls suggesting protections for people with pre-existing conditions are very popular, many Republicans running in tight races are campaigning to preserve protections, while omitting their past votes related to the policy. Cruz, however, is still crusading to repeal Obamacare, unlike most of his Republican colleagues. But he’s also vowing to defend protections that are a central to the 2010 health law.    

“On Obamacare, I wanna repeal Obamacare, reduce premiums, protect pre-existing conditions, and expand access,” said the Texas senator during his closing argument. “Congressman O’Rourke wants socialized medicine, the federal government in charge of your health care and your doctor — which, among other things, threaten to bankrupt Medicare.”

Cruz’s pledges foil his Senate record — a point O’Rourke brought up earlier in the debate. 

“It’s the same person who shut down the government of the United States of America for 16 days — perhaps, because he thought too many people have too much health care, voted to take away health care from millions of American families, and vows to repeal protections for pre-existing conditions,” said O’Rourke. Cruz, who was laughing throughout, interjected during O’Rourke’s closing comment to say “not true.”

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But it is true. In 2013, Cruz shut down the federal government for 16 days, aiming to end funding for the ACA. While stripping Obamacare funding doesn’t eliminate consumer protections, it does eliminate federal subsidies that make coverage affordable for people with pre-existing conditions. Healthy people could take their chances and forgo coverage if they can no longer afford it without government aid, but sick people can’t.

“Defunding destabilizes markets,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation (KFF).

“This is all a complicated weave of protections so if you defund, then you take away the subsidies,” Pollitz told ThinkProgress. “Subsidies do a tremendous job in stabilizing marketplaces.”

In 2015, Cruz also voted to eliminate protections for people with pre-existing conditions by agreeing to repeal Obamacare without any replacement. If Republicans had been successful, an estimated 4.5 million Texans with pre-existing conditions would be uninsurable if they applied for marketplace coverage.

In 2017, Cruz not only voted in favor of two GOP health bills that would have weakened coverage for people with pre-existing conditions, but he also crafted legislation that did as much. The Cruz amendment would have allowed insurance companies to sell whatever bare bones health plans they desired as long as they also sold at least one with Obamacare’s comprehensive benefits.

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“The Cruz Amendment would have resulted in non-compliant plans siphoning off healthier people, while ACA-compliant plans would be left with a sicker pool and higher premiums,” said KFF’s Larry Levitt on Twitter. “This is similar to what will happen with the short-term plans being expanded by the Trump administration.”

(The Trump administration is being sued for its short-term plan policy.)

While Cruz was being honest when he said he’d fight for lower premiums, the problem Republicans are facing is that lowering premiums and providing quality coverage is difficult without heavy government involvement. And any Democratic suggestion to include the government is unfairly lambasted as “socialized medicine.”

It’s also true that under Medicare for All, people would enroll in one government plan, as Cruz said. But it’s inaccurate to say implementing a universal health care system by relying on the federal government (as with single-payer) doesn’t work anywhere in the world, as Cruz and the president have argued. There are trade-offs under Medicare for All, as with any health policy. But to say Medicare for All will bankrupt Medicare is not arguing in good faith.

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Cruz is attempting to make the midterm elections a referendum on Medicare for All, but it’s unlikely this kind of legislation is going anywhere until after the 2020 presidential election. But if November goes well for Republicans, they’ll try to repeal Obamacare again — Vice President Mike Pence said as much in August.