When Pamela Jean Locke votes in November, one issue she’ll be thinking about is protections for Americans with pre-existing health problems.
“I think people should be able to have insurance even if they have pre-existing conditions,” said Ms. Locke, 59, who works in Jacksonville, Fla., as a children’s museum director. She recalls jumping from one plan to another before Obamacare, when her husband’s heart condition threatened to cut them off from coverage.
She plans to cast her vote for President Trump in November, and expects he’ll do a good job on the issue, despite a policy record that is at odds with that premise.
“I’ve heard from him that he would continue with pre-existing conditions so that people would not lose their health insurance,” she said. “It’s made a big difference with me and my husband.”
Joe Biden and Democratic candidates for Congress are campaigning heavily on the issue, arguing that another term of a Trump presidency would mean a rollback of insurance protections that are extremely popular. Mr. Biden pressed the issue at Tuesday night’s presidential debate, saying “there’s 100 million people that have pre-existing conditions” who could see their access to insurance “taken away.”
That case seems to sway Democratic and independent voters, but not Republicans: Recent polls show the party’s voters believe the president will do the best job of protecting those with pre-existing conditions. They believe the repeated promises he makes, at campaign rallies, in Twitter messages and with executive orders — despite his support of lawsuits and legislation that would do the opposite.
A recent survey from the Kaiser Family Foundation found that 84 percent of Republican adults said Trump had the “better approach” for people with pre-existing conditions. Another, from the Commonwealth Fund, found that 81 percent of Republican likely voters said he was “more likely to protect health insurance coverage” for such people.
“I think he’s talked to enough families who have pre-existing conditions and wouldn’t have insurance, who wouldn’t be able to get the care they need,” Ms. Locke said, explaining why she thinks President Trump will make sure insurers can’t turn away sick patients.
The New York Times talked to a dozen voters who said President Trump would do a better job on pre-existing conditions, with the interviews focusing on why they held that view and how they came to it. Some felt the protections were important to them personally, either because of their conditions of those of immediate family members.
They cited remarks the president had been making, particularly at rallies, about continuing to ban insurers from turning away sick patients. “I had a choice to make very early on,” President Trump said at the debate. “We took away the individual mandate. We guaranteed pre-existing conditions.”
They often expressed disbelief that any politician would try to touch the popular provision.
“There is not a single guy or woman who would run for president that would make it so that pre-existing conditions wouldn’t be covered,” said Phil Bowman, a 59-year-old retiree in Linville, N.C. “Nobody would vote for him.”
Mr. Bowman cast his ballot for President Trump in 2016, and supports him in this election as well.
President Trump has supported unsuccessful legislation to replace the Affordable Care Act with policies that would put sicker patients at a disadvantage in the insurance market. And his Justice Department is currently asking the Supreme Court to overturn the law, with no replacement.
On Thursday, the president announced an executive order protecting pre-existing conditions — but they are already protected under Obamacare. No president can simply order insurers to cover sick people. And the health care system is so complex that any significant change would require complex legislation.
Mr. Trump’s secretary of health and human services, Alex Azar, has acknowledged as much, saying that the order would have no force of law if Obamacare were overturned in the courts, and that the administration would need to turn to Congress.
Mr. Trump’s supporters, however, appear to be taking his promises about protecting those with pre-existing conditions at face value.
“I think he’s straight up telling us what he’s going to do,” said Ronald Regal, a retired garbage collector who lives in Ocala, Fla. “He has done what he wanted to do, and told us what he was going to do with all the things he has done.”
The Affordable Care Act has become a part of American life, and that may help Mr. Trump remain persuasive on this issue, said Mollyann Brodie, the chief operating officer at the Kaiser Family Foundation, who helped write one of the recent surveys. In the past, the prospect of losing insurance because of health problems was real. Now, voters have lived with the protections for a decade.
“They all have insurance now, and they can’t lose it because of a pre-existing condition,” she said. “And why would President Trump change that? It’s a consistent position if you trust him.”
For such voters, Mr. Trump’s vague promises may be sufficient to reassure them.
“I saw it on Facebook, while he was at a rally,” said James Geisler, 52, who plans to vote for President Trump in November. “He didn’t really go into specifics on that issue. He just said any pre-existing conditions will be covered under my plan.”
When asked what they disliked about Mr. Biden’s plans, they often cited his age as a major issue rather than the policies he has proposed. Mr. Biden, 77, is three years older than Mr. Trump, 74.
Robert Blendon, a professor at the Harvard School of Public Health, who studies public opinion on health care, said he was not surprised to see so many Republican voters backing Trump on the issue despite his policy record. Republican voters continue to dislike Obamacare, he said, and expect Mr. Trump to replace it with something better.
“It’s strictly partisanship,” he said. “If I’ve decided to go with him, I believe he won’t hurt, quote, me or someone like me. But it’s not substantively based.”
But he noted that Mr. Trump didn’t fare nearly as well on the question among Democrats and independents, a weakness that could hurt him in the election if Democrats succeeded in elevating the issue in coming weeks.
In the Commonwealth Fund poll, 36 percent of Republican likely voters said protections for pre-existing conditions were a “very important factor” in their vote.
Some considered it important to themselves personally. Elaine, a voter in Georgia who asked to be identified by only her first name because of privacy concerns, has a son with schizophrenia.
“I would hate for him to ever be denied any type of medical care because of that going forward,” she said.
She isn’t a fan of Mr. Trump’s personality but feels his list of accomplishments in office is strong. She believes that, if given a second term in office, he would protect Americans like her son.
“I truly, in my heart of hearts, believe that even though he sometimes says things I don’t like, and acts in ways I wish he wouldn’t, I still think he has everybody’s best interest at heart,” she said. “I just cannot see him allowing for pre-existing conditions to come back.”