To feel comfortable, patients need to take stock of the precautions providers are taking.

This article was first published on Monday, July 6, 2020 in Kaiser Health News.

By Judith Graham   

For months, Patricia Merryweather-Arges, a health care expert, has fielded questions about the coronavirus pandemic from fellow Rotary Club members in the Midwest.

Recently people have wondered "Is it safe for me to go see my doctor? Should I keep that appointment with my dentist? What about that knee replacement I put on hold: Should I go ahead with that?"

These are pressing concerns as hospitals, outpatient clinics and physicians' practices have started providing elective medical procedures — services that had been suspended for several months.

Late last month, KFF reported that 48% of adults had skipped or postponed medical care because of the pandemic. Physicians are deeply concerned about the consequences, especially for people with serious illnesses or chronic medical conditions.

To feel comfortable, patients need to take stock of the precautions providers are taking. This is especially true for older adults, who are particularly vulnerable to COVID-19. Here are suggestions that can help people think through concerns and decide whether to seek elective care:

Before you go in. Give yourself at least a week to learn about your medical provider's preparations. "You want to know in advance what's expected of you and what you can expect from your providers," said Lisa McGiffert, co-founder of the Patient Safety Action Network.

Merryweather-Arges' organization, Project Patient Care, has developed a guide with recommended questions. Among them: Will I be screened for COVID-19 upon arrival? Do I need to wear a mask and gloves? Are there any restrictions on what I can bring (a laptop, books, a change of clothing)? Are the areas I'll visit cleaned and disinfected between patients?

Also ask whether patients known to have COVID are treated in the same areas you'll use. Will the medical staffers who interact with you also see these patients?

If you're getting care in a hospital, will you be tested for COVID-19 before your procedure? Is the staff being tested and, if so, under what circumstances?

Hospitals, medical clinics and physicians are offering this kind of information to varying degrees. In the New York City metropolitan area, Mount Sinai Health System has launched a comprehensive "Safety Hub" on its website featuring extensive information and videos.

Mount Sinai also encourages physicians to reach out to patients with messages tailored to their conditions. People "want to hear directly from their providers," said Karen Wish, the system's chief marketing officer.

Don't hesitate to press for more details, said Dr. Allen Kachalia, senior vice president of patient safety and quality at Johns Hopkins Medicine: "Where people get in trouble is when they're afraid to bring their concerns forward."

Seeking care. Wendy Hayum-Gross, 57, a counselor who lives in Naperville, Illinois, had been waiting since mid-March to get blood tests that would help doctors diagnose the underlying cause of a new condition, a goiter. A few weeks ago, she decided it was time.

The hospital lab she went to, operated by Edward-Elmhurst Health, told Hayum-Gross to wear a mask and gave her a number to call when she arrived in the parking lot. Outside the front door, she was met by a staffer who took her temperature, asked several screening questions and gave her hand sanitizer.

"Once I passed that, a phlebotomist met me on the other side of the door and took me to a chair that was still wet with disinfectant. She wore a mask and gloves, and there was no one else around," Hayum-Gross said. "When I saw the precautions they had put in place and the almost military precision with which they were carrying them out, I felt much better."

Marjorie Helsel DeWert, 67, of Athens, Ohio, was similarly impressed when she visited her dentist recently and noticed circular yellow signs on the floor of the office, spaced 6 feet apart, indicating where people should stand. Staffers had even put pens used to fill out paperwork in individual containers and arranged to disinfect them after use.

DeWert, a learning scientist, came up with a patient safety checklist and distributed it to family and friends. Among her questions: Can necessary forms be completed online before a medical visit? Can I wait in the car outside until called? What kind of personal protective equipment is the staff using? And is the staff being checked for symptoms daily?

Bringing a caregiver. Some medical centers are allowing caregivers to accompany patients; others are not. Be sure to ask what policies are in place.

If you feel your presence is necessary — for instance, if you want to be there for a relative who is frail or cognitively compromised — be firm but also respectful, said Ilene Corina, president of the Pulse Center for Patient Safety Education & Advocacy.

Be prepared to wear a gown, gloves and mask. "You're not there for yourself: You're there to support the health care team and the patient," said Corina, whose organization offers training to caregivers.

In Orland Park, Illinois, debi Ross, an interior designer, and her sister live with her 101-year-old mother. Eight years ago, when her mother had a tumor removed from her colon, Ross and her sister wiped down every electric socket, cord, surface and door handle in her mother's hospital room.

"Unless Mom absolutely needs [medical] care, we're not going to take her anywhere," Ross said. "But I assure you, if she does have to go see somebody, we're going to clean that place down from top to bottom, I don't care what anybody says."

If you are not allowed into a medical facility, get a phone number for the physician caring for a loved one and make sure they have your number as well, Merryweather-Arges said. Ask that you be contacted immediately if there are any complications.

Afterward. Patients leaving hospitals are fearful these days that they may have become infected with COVID-19, unwittingly. Ask your physician or a nurse what equipment you'll need to monitor yourself. Will a pulse oximeter and a thermometer be necessary? Will you need masks and gloves at home if someone is coming in to help you out with the transition? Can someone provide that equipment?

"Family caregivers need instructions that are clear," said Martin Hatlie, chief executive of Project Patient Care. "They need to know who to call 24/7 if they have a question. And they need clear guidance about infection control in the home."

If home care is being ordered, ask the agency whether they have trained staff to recognize COVID symptoms. And have home care workers been tested for COVID-19 or had symptoms?

If follow-up care is being provided via telehealth, make sure the setup works before your loved one comes home. Ask your physician's office what kind of equipment you will need, which service they use (Zoom? Skype?) and whether you can arrange a test in advance.

Finally, as you resume activities, help protect others against COVID-19 as well as yourself. When you go out into the world again, "mask up, socially distance and wash your hands," said Kachalia of Johns Hopkins. "And if you're sick or have symptoms, by all means, let your doctor's office know before you come in for a checkup."

Judith Graham: khn.navigatingaging@gmail.com, @judith_graham

Proponents believe the simple test, which can be done at home, may help the U.S. move closer to eradicating cervical cancer.

By Charlotte Huff  

This article was first published on Wednesday, July 1, 2020 in Kaiser Health News.

With a tiny brush, briefly swab the vagina to collect cells. Then slide the swab into a screening kit and drop it into the mail.

Proponents believe a simple test like this, which can be done at home, may help the U.S. move closer to eradicating cervical cancer. The National Cancer Institute plans to launch a multisite study next year involving roughly 5,000 women to assess whether self-sampling at home is comparable to screening in the office by a clinician.

Nearly 14,000 Americans this year will be diagnosed with the highly preventable cancer, and more than 4,000 will die. Women who are uninsured or can't get regular medical care are more likely to miss out on lifesaving screening, said Vikrant Sahasrabuddhe, a program director in the NCI's Division of Cancer Prevention. If women could collect the vaginal and cervical cells to be tested for human papillomavirus (HPV) — the virus that causes virtually all cervical cancers — they could get screened from home, just as home-based stool samples can be used to detect colon cancer, he said.

"What we have seen is this persistent group of women who continue to get cervical cancer every year," said Sahasrabuddhe, who oversees studies involving HPV-related cancers. "And that number is really not going down."

Federal officials hope the research will fast-track a test approved by the Food and Drug Administration that could be part of screening guidelines if self-sampling is proved effective, Sahasrabuddhe said. Rather than wait for self-sampling studies to be done by the individual companies that make the HPV tests for clinicians, federal officials will team up with the companies, academic institutions and others in a public-private partnership, he explained. NCI officials, who expect to spend about $6 million in federal funds, will oversee the study's data and analysis.

"If every company goes and does their own trial, they may take years to achieve it," Sahasrabuddhe said. "We want to accelerate that process."

HPV self-sampling, already promoted in countries such as Australia and the Netherlands, is one of several approaches that U.S. cervical cancer researchers are pursuing. Another key strategy involves vaccinating adolescents against HPV, which is transmitted through sexual activity. As of 2018, nearly 54% of girls had been fully vaccinated by age 17, as had almost 49% of boys, according to the most recent federal data. The countries that have had better success in reducing cervical cancer — one analysis predicts that Australia is on track to eliminate the disease — have emphasized HPV vaccination for adolescents.

Federal officials still advise vaccinated women to get regularly screened, as the vaccine doesn't guard against all the strains that cause cervical cancer. But persuading some women to come into the office for the physical exam is sometimes a tough sell.

For some, access or cost may be an issue. Most insurance plans cover screening and there are also some public programs, but uninsured women who are unaware of them may have to pay for an office visit and test. Besides, women can't always break away from work or find child care, or they may have had "negative emotions or experiences in the past with pelvic exams," said Rachel Winer, a professor of epidemiology at the University of Washington School of Public Health who studies HPV self-sampling.

Reversing The Trend

Roughly 4 out of 5 women get regularly screened for cervical cancer, but the rates peaked around 2000 and have been on a slight decline since, according to federal data. That figure, which is based on patient self-reporting, may be optimistic. Another analysis, which looked at the medical records of 27,418 Minnesota women ages 30 to 65, found that nearly 65% were up to date as of 2016, according to the findings, published last year in the Journal of Women's Health.

"Sadly, I think our data is probably more reflective of what's happening with screening rates in our country," said Dr. Kathy MacLaughlin, a study author and researcher at Mayo Clinic in Rochester, Minnesota.

One hurdle to getting screened may be the complexity of the guidelines, MacLaughlin said. Rather than an easy-to-remember annual exam, screenings occur at intervals of longer than a year. A woman's age helps determine when the HPV test or a Pap smear, which collects cells from the cervix to look for precancerous changes, is recommended by the U.S. Preventive Services Task Force.

"It's just that challenge of, how do any of us remember to do something every three years or every five years?" MacLaughlin said. "That's hard."

At-Home Logistics

While the NCI hasn't yet settled on the precise self-sampling approach it will use, the technique generally requires the woman to insert a tiny brush into her vagina and rotate it several times to collect the cells. Then she slides the brush into a specimen container that has a preservative solution and returns the kit for HPV analysis.

According to a review of studies published in 2018 in the medical journal BMJ, the accuracy of identifying HPV was similar when the samples were collected by women at home as when collected by clinicians. A urine-based HPV test, which may prove easier for women to perform, also is being studied, said Jennifer Smith, a professor of epidemiology at the University of North Carolina's Gillings School of Global Public Health.

Before companies can pursue applications for an FDA-approved home test, self-sampling by women has to be shown comparable to detect HPV, though perhaps it may not be quite as accurate as when a clinician is involved, Sahasrabuddhe said. NCI officials are still finalizing study details. But the plan is to invite four companies that already manufacture HPV tests for clinicians to participate, Sahasrabuddhe said. The companies will pick up the tab for the cost of the tests as well as future fees related to pursuing license applications through the FDA, he said. Sahasrabuddhe expects the study results to be available by 2024, if not sooner.

Any woman who tests positive for HPV will be referred for procedures, including possibly a biopsy, to look for abnormal cells or cervical cancer, Sahasrabuddhe said.

If an FDA-approved home test is developed, it's crucial that uninsured women and others who don't have easy access to medical care be able to get those procedures, Smith said.

"You just don't send random kits out to people's homes," Smith said, "and not ensure that they have someone to talk to about the results and are going to be able to be integrated into a follow-up system."

Since March, more than 4,100 COVID-related complaints regarding health care facilities have poured into the nation's network of federal and state OSHA offices.

This article was first published on Tuesday, June 30, 2020 in Kaiser Health News.

By Christina Jewett and Shefali Luthra and Melissa Bailey  

COVID-19 cases were climbing at Michigan's McLaren Flint hospital. So Roger Liddell, 64, who procured supplies for the hospital, asked for an N95 respirator for his own protection, since his work brought him into the same room as COVID-positive patients.

But the hospital denied his request, said Kelly Indish, president of the American Federation of State, County and Municipal Employees Local 875.

On March 30, Liddell posted on Facebook that he had worked the previous week in both the critical care unit and the ICU and had contracted the virus. "Pray for me God is still in control," he wrote. He died April 10.

The hospital's problems with personal protective equipment (PPE) were well documented. In mid-March, the state office of the Occupational Safety and Health Administration (OSHA) received five complaints, which described employees receiving "zero PPE." The cases were closed April 21, after the hospital presented paperwork saying problems had been resolved. There was no onsite inspection, and the hospital's written response was deemed sufficient to close the complaints, a local OSHA spokesperson confirmed.

The grief and fear gripping workers and their families reflect a far larger pattern. Since March, more than 4,100 COVID-related complaints regarding health care facilities have poured into the nation's network of federal and state OSHA offices, which are tasked with protecting workers from harm on the job.

A KHN investigation found that at least 35 health care workers died after OSHA received safety complaints about their workplaces. Yet by June 21, the agency had quietly closed almost all of those complaints, and none of them led to a citation or a fine.

The complaint logs, which have been made public, show thousands of desperate pleas from workers seeking better protective gear for their hospitals, medical offices and nursing homes.

The quick closure of complaints underscores the Trump administration's hands-off approach to oversight, said former OSHA official Deborah Berkowitz. Instead of cracking down, the agency simply sent letters reminding employers to follow Centers for Disease Control and Prevention guidelines, said Berkowitz, now a director at the National Employment Law Project.

"This is a travesty," she said.

A third of the health care-related COVID-19 complaints, about 1,300, remain open and about 275 fatality investigations are ongoing.

During a June 9 legislative hearing, Labor Secretary Eugene Scalia said OSHA had issued one coronavirus-related citation for violating federal standards. A Georgia nursing home was fined $3,900 for failing to report worker hospitalizations on time, OSHA's records show.

"We have a number of cases we are investigating," Scalia said at the Senate Finance Committee hearing. "If we find violations, we will certainly not hesitate to bring a case."

 A March 16 complaint regarding Clara Maass Medical Center in Belleville, New Jersey, illustrates the life-or-death stakes for workers on the front lines. The complaint says workers were "not allowed to wear" masks in the hallway outside COVID-19 patients' rooms even though studies have since shown the highly contagious virus can spread throughout a health care facility. It also said workers "were not allowed adequate access" to PPE.

Nine days later, veteran Clara Maass registered nurse Barbara Birchenough texted her daughter: "The ICU nurses were making gowns out of garbage bags. … Dad is going to pick up large garbage bags for me just in case."

Kristin Carbone, the eldest of four, said her mother was not working in a COVID area but was upset that patients with suspicious symptoms were under her care.

In a text later that day, Birchenough admitted: "I have a cough and a headache … we were exposed to six patients who we are now testing for COVID 19. They all of a sudden got coughs and fevers."

"Please pray for all health care workers," the text went on. "We are running out of supplies."

By April 15, Birchenough, 65, had died of the virus. "They were not protecting their employees in my opinion," Carbone said. "It's beyond sad, but then I go to a different place where I'm infuriated."

OSHA records show six investigations into a fatality or cluster of worker hospitalizations at the hospital. A Labor Department spokesperson said the initial complaints about Clara Maass remain open and did not explain why they continue to appear on a "closed" case list.

Nestor Bautista, 62, who worked closely with Birchenough, died of COVID-19 the same day as she did, according to Nestor's sister, Cecilia Bautista. She said her brother, a nursing aide at Clara Maass for 24 years, was a quiet and devoted employee: "He was just work, work, work," she said.

Responding to allegations in the OSHA complaint, Clara Maass Medical Center spokesperson Stacie Newton said the virus has "presented unprecedented challenges."

"Although the source of the exposure has not been determined, several staff members" contracted the virus and "a few" have died, Newton said in an email. "Our staff has been in regular contact with OSHA, providing notifications and cooperating fully with all inquiries."

Other complaints have been filed with OSHA offices across the U.S.

Twenty-one closed complaints alleged that workers faced threats of retaliation for actions such as speaking up about the lack of PPE. At a Delaware hospital, workers said they were not allowed to wear N95 masks, which protected them better than surgical masks, "for fear of termination or retaliation." At an Atlanta hospital, workers said they were not provided proper PPE and were also threatened to be fired if they "raise[d] concerns about PPE when working with patients with Covid-19."

Of the 4,100-plus complaints that flooded OSHA offices, over two-thirds are now marked as "closed" in an OSHA database. Among them was a complaint that staffers handling dead bodies in a small room off the lobby of a Manhattan nursing home weren't given appropriate protective gear.

More than 100 of those cases were resolved within 10 days. One of those complaints said home health nurses in the Bronx were sent to treat COVID-19 patients without full protective gear. At a Massachusetts nursing home that housed COVID patients, staff members were asked to wash and reuse masks and disposable gloves, another complaint said. A complaint about an Ohio nursing home said workers were not required to wear protective equipment when caring for COVID patients. That complaint was closed three days after OSHA received it.

It remains unclear how OSHA resolved hundreds of the complaints. A Department of Labor spokesperson said in an email that some are closed based on an exchange of information between the employer and OSHA, and advised reporters to file Freedom of Information Act requests for details on others.

"The Department is committed to protecting America's workers during the pandemic," the Labor Department said in a statement. "OSHA has standards in place to protect employees, and employers who fail to take appropriate steps to protect their employees may be violating them."

The agency advised its inspectors on May 19 to place reports of fatalities and imminent danger as a top priority, with a special focus on health care settings. Since late March, OSHA has opened more than 250 investigations into fatalities at health care facilities, government records show. Most of those cases are ongoing.

According to the mid-March complaints against McLaren Flint, workers did not receive needed N95 masks and "are not allowed to bring them from home." They also said patients with COVID-19 were kept throughout the hospital.

Filing complaints, though, did little for Liddell, or for his colleague, Patrick Cain, 52. After the complaints were filed, Cain, a registered nurse, was treating people still awaiting the results of COVID-19 diagnostic tests — potentially positive patients ― without an N95 respirator. He was also working outside a room where potential COVID-19 patients were undergoing treatments that research supported by the University of Nebraska has since shown can spread the virus widely in the air.

At the time, there was a debate over whether supply chain breakdowns of PPE and weakened CDC guidelines on protective gear were putting workers at risk.

Cain felt vulnerable working outside of rooms where COVID patients were undergoing infection-spreading treatments, he wrote in a text to Indish on March 26.

"McLaren screwed us," he wrote.

He fell ill in mid-March and died April 4.

McLaren has since revised its face-covering policy to provide N95s or controlled air-purifying respirators (CAPRs) to workers on the COVID floor, union members said.

A spokesperson for the McLaren Health Care system said the OSHA complaints are "unsubstantiated" and that its protocols have consistently followed government guidelines. "We have always provided appropriate PPE and staff training that adheres to the evolving federal, state, and local PPE guidelines," Brian Brown said in an email.

Separate from the closed complaints, OSHA investigations into Liddell and Cain's deaths are ongoing, according to a spokesperson for the state's Department of Labor and Economic Opportunity.

Nurses at Kaiser Permanente Fresno Medical Center also said the complaints they aired before a nurse's death have not been resolved. (KHN is not affiliated with Kaiser Permanente.)

On March 18, nurses filed an initial complaint. They told OSHA they were given surgical masks, instead of N95s. Less than a week later, other complaints said staffers were forced to reuse those surgical masks and evaluate patients for COVID without wearing an N95 respirator.

Several nurses who cared for one patient who wasn't initially suspected of having COVID-19 in mid-March wore no protective gear, according to Amy Arlund, a Kaiser Fresno nurse and board member of the National Nurses Organizing Committee board of directors. Sandra Oldfield, a 53-year-old RN, was among them.

Arlund said Oldfield had filed an internal complaint with management about inadequate PPE around that time. Arlund said the patient's illness was difficult to pin down, so dozens of workers were exposed to him and 10 came down with COVID-19, including Oldfield.

Lori Rodriguez, Oldfield's sister, said Sandra was upset that the patient she cared for who ended up testing positive for COVID-19 hadn't been screened earlier.

"I don't want to see anyone else lose their life like my sister did," she said. "It's just not right."

Wade Nogy, senior vice president and area manager of Kaiser Permanente Fresno, confirmed that Oldfield had exposure to a patient before COVID-19 was suspected. He said Kaiser Permanente "has years of experience managing highly infectious diseases, and we are safely treating patients who have been infected with this virus."

Kaiser Permanente spokesperson Marc Brown said KP "responded to these complaints with information, documents and interviews that demonstrated we are in compliance with OSHA regulations to protect our employees." He said the health system provides nurses and other staff "with the appropriate protective equipment."

California OSHA officials said the initial complaints were accurate and the hospital was not in compliance with a state law requiring workers treating COVID patients to have respirators. However, the officials said the requirement had been waived due to global shortages.

Kaiser Fresno is now in compliance, Cal/OSHA said in a statement, but the agency has ongoing investigations at the facility.

Arlund said tension around protective gear remains high at the hospital. On each shift, she said, nurses must justify their need for a respirator, face shield or hair cap. She expressed surprise that the OSHA complaints were considered "closed."

"I'm very concerned to hear they are closing cases when I know they haven't reached out to front-line nurses," Arlund said. "We do not consider any of them closed."

Christina Jewett: ChristinaJ@kff.org, @by_cjewett

Shefali Luthra: ShefaliL@kff.org, @Shefalil

Melissa Bailey: @mmbaily

"Of course I will always protect those with preexisting conditions. Always." — U.S. Sen. Martha McSally, in a campaign ad released June 22.

This article was first published on Monday, June 29, 2020 in Kaiser Health News.

By Shefali Luthra

Trailing Democratic challenger Mark Kelly in one of the country’s most hotly contested Senate races, Arizona Sen. Martha McSally is seeking to tie herself to an issue with across-the-aisle appeal: insurance protections for people with preexisting health conditions.

“Of course I will always protect those with preexisting conditions. Always,” the Republican said in a TV ad released June 22.

The ad comes in response to criticisms by Kelly, who has highlighted McSally’s votes to undo the Affordable Care Act. That, he argued, would leave Americans with medical conditions vulnerable to higher-priced insurance.

The Arizona Senate race has attracted national attention and is considered a toss-up, though Kelly is leading in many polls. McSally’s attempt to present herself as a supporter of protecting people with preexisting conditions — a major component of the 2010 health law — is part of a larger pattern in which vulnerable Republican incumbents stake out positions advocating for this protection while also maintaining the GOP’s strong stance against the ACA.

McSally, who was appointed by the governor to take over John McCain’s Senate seat in 2019, used similar messaging in her failed 2018 bid for the state’s other Senate position. And President Donald Trump echoed the declaration at a June 23 rally in Phoenix, saying McSally — along with the rest of the Republican Party — “will always protect people with preexisting conditions.”

With that in mind, we decided to take a closer look. We contacted McSally’s campaign, which cited her support of a different piece of legislation, the Protect Act. But independent experts told us that legislation doesn’t satisfy the standard she sets out.

Past and Present

Only one national law makes sure people with preexisting medical conditions don’t face discrimination or higher prices from insurers. It’s the Affordable Care Act.

Both as a member of the House of Representatives and as a senator, McSally has supported efforts to undo the health law — voting in 2015 to repeal it and in 2017 to replace it with the Republican-backed American Health Care Act, which would have permitted insurers to charge higher premiums for people with complicated medical histories.

“Anyone who voted for that bill was voting to take away the ACA’s preexisting condition protections,” said Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill. “Sen. McSally is trying to erase history for electoral purposes.”

Especially as COVID-19 cases climb, health care — and, in particular, the ACA — has emerged as a flashpoint in the Arizona election, said Dr. Daniel Derksen, a professor of public health, medicine and nursing at the University of Arizona.

“Martha McSally has in her actions, in her votes, been pretty consistent about cutting back benefits and trying to repeal the ACA without any clear plan in mind that would protect people who gained insurance through the ACA,” Derksen added. “Her words on preexisting condition protections don’t align with any votes I’ve seen.”

McSally’s campaign argued that the ACA is just one strategy, and a flawed one at that. Dylan Lefler, her campaign manager, instead pointed to her support of the Republican-backed Protect Act as evidence to back up her promise. Specifically, it ostensibly bans insurance plans from “impos[ing] any preexisting condition exclusion with respect to … coverage,” per the bill text.

The problem, though, is that simply banning that exclusion isn’t enough, because the law also has to make sure the health insurance plans that cover preexisting conditions remain affordable. The bill, sponsored by Sen. Thom Tillis (R-N.C.), does nothing to provide subsidies or cost-sharing mechanisms — meaning people both with and without preexisting conditions wouldn’t necessarily be able to afford those plans. Without that framework, the act remains a “meaningless promise,” argued Linda Blumberg, a fellow at the Urban Institute, a social policy think tank.

And it has other holes: for instance, permitting insurers to charge women more than men.

“No six-page bill is ever the way of achieving something,” said Thomas Miller, a scholar at the American Enterprise Institute. “This is a check-the-box effort to try to say, ‘We’re [moving] in that direction.’”

It’s not just legislation. There’s also Texas v. Azar, a pending case in which a group of Republican attorneys general are arguing the Supreme Court should strike the entire health law, including its preexisting condition protections. The Trump administration has sided with the Republican states.

McSally has consistently declined to comment on the lawsuit, saying she doesn’t want to weigh in on “a judicial proceeding.” In reporting this fact check, we asked where she stood on the case. The campaign didn’t specifically answer but pointed to her general disapproval of the ACA. Meanwhile, Senate Democrats have called on the administration to reverse its stance.

That context makes McSally’s silence especially relevant, said Sabrina Corlette, a research professor at Georgetown University.

“When given the opportunity, she has declined to oppose this lawsuit, which would essentially eliminate the protections that exist,” Corlette said.

So — big picture? McSally’s record in Washington hasn’t been one of preserving or building on preexisting condition protections.

Our Ruling

In her new TV ad, McSally claims she will “always protect those with preexisting conditions.”

But nothing in her voting record, which tracks closely with the Republican repeal-and-replace philosophy, supports this claim. And she has continually declined opportunities to oppose a pending legal threat to the ACA, including its provisions related to preexisting conditions, by a group of GOP governors and supported by the Trump administration.

Meanwhile, the legislation her campaign cited to justify her stance falls short in terms of meaningfully protecting Americans with preexisting medical conditions.

McSally has not in the past or present taken actions that back up her statement. We rate it False.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.