As Republicans on the campaign trail have contorted the truth about their monthslong campaign to undo the 2010 health care law, they’ve provoked a tricky opponent: cancer survivors.

Republicans have tried to contain the damage of their “repeal and replace” push as they defend their majorities in the midterm elections. In order to pull that off, the campaigns have had to find ways to discredit the sympathetic voices of people with complex medical needs who opposed their votes.

These health care advocates include people who got engaged in advocacy for the first time because of Republicans’ attempts to dismantle the law. They are patients with serious health conditions who are covered through the law’s marketplaces and patients who rely on Medicaid. They worry that without the law they could go into bankruptcy or go without care.

Republicans point to their support for state insurance pools as a source for coverage for high-risk patients, and more recent legislation that would ensure that people with pre-existing conditions can secure coverage, even if insurers wouldn’t necessarily cover care for those conditions. But the advocates aren’t buying it. 

Their voices have been amplified by viral videos, by campaign ads and by organizations like Indivisible and Protect Our Care, an issue advocacy group that aligns with Democrats.

“They’re effective messengers because they’re all of us,” said Protect Our Care Communications Director Amanda Harrington. “We all know someone who wouldn’t be insurable without the ACA.”

Jeff Jeans

Jeff Jeans, a health care advocate and cancer survivor who lives in Sedona, Arizona, said he “nearly spit out his coffee” when, while watching the morning news, he saw an ad showing his picture with the word “FALSE” stamped over his face in red letters.

The ad was paid for by DefendArizona, a super PAC aligned with Senate Republicans that has spent nearly $22 million boosting Arizona Senate candidate Rep. Martha McSally — twice as much as McSally’s campaign.

Other than that, little is known about the PAC: It lists a mailbox at an Arizona UPS store as its address on the paperwork filed to the Federal Election Commission. Jeans shared a cellphone recording of the ad with Roll Call because it doesn’t appear on DefendArizona’s YouTube page. In an interview, a spokesman wouldn’t say who steers the group’s strategy.

The PAC has accepted six-figure contributions from autodealers and Silicon Valley billionaires, but its largest donor is the Senate Leadership Fund, a super PAC with close ties to Senate Majority Leader Mitch McConnell, FEC records show.

Jeans briefly became a national figure in January 2017, around the time President Donald Trump asked the Republican leadership in Congress to prioritize undoing the law not long after he took office.

Jeans said he sought treatment for throat cancer in the intensive care unit before gaining coverage through the ACA marketplaces. At a town hall televised on CNN, he shared that he was a former Republican who once opposed the law. But that was before he got sick.

“Thanks to the Affordable Care Act, I’m standing here alive,” Jeans said. “Why would you repeal the Affordable Care Act without a replacement?” he asked House Speaker Paul Ryan.

The video went viral.

“My advocacy really snowballed after that,” Jeans said.

Today Jeans is cancer-free. But he was energized by the health care battle in Congress “because my perceptions of health care in this country were so wrong, and I didn’t realize it until I was on my deathbed in the hospital.”

Jeans recently appeared in an ad paid for by Majority Forward, a 501(c)(4) issue advocacy group aligned with Senate Democrats. McSally is locked in a close race with Democrat Rep. Kyrsten Sinema that Inside Elections with Nathan L. Gonzales rates a Toss-up.

“People with pre-existing conditions are everywhere. Your children, your parents,” Jeans says into the camera. “Taking health care away from those people? It just wrong,” he continues, a reference to McSally’s vote in favor of the American Health Care Act.

It’s a moving message, one DefendArizona has sought to undercut.

The super PAC’s counter ad shows a screengrab of Jeans while a narrator intones, “Those ads attacking Martha McSally? They’re telling a whopper of a lie.”

Asked what that implies, Jeans said, “Well it says ‘FALSE’ right over my face.”

DefendArizona stood behind its decision to feature someone who could one day be a McSally constituent in an attack ad.

“How do you respond if you cannot call out the inaccuracies in an ad? I’m at a loss of what could be done,” spokesman Barrett Marson said. “We’re certainly not attacking him. We’re attacking the things he said that are not accurate,” he said, reiterating a claim that McSally and other Republicans have made on the campaign trail: that they voted to protect pre-existing conditions.

In fact, though the Republican-held Congress considered many proposals in 2017 — most seriously the American Health Care Act, which passed the House, and “skinny repeal,” which failed in the Senate by one vote — and each differed in approach, rolling back protections for patients with pre-existing conditions was a primary goal, nonpartisan health policy analysts say.

Those plans failed to become law, but advocates’ hard-won protections could be overturned anyway: The law may be invalidated in the courts, where the Trump’s Department of Justice has argued protections for pre-existing conditions are unconstitutional.

“In a political campaign, it’s not unusual for candidates to make broad promises, like protecting people with pre-existing conditions,” Larry Levitt, a health policy expert at the Kaiser Family Foundation said in a tweet. “What’s different in this campaign is that some candidates voted on actual bills to weaken those protections or filed a lawsuit to overturn them.”

Andrea Mitchell

Around the same time Jeans became an unlikely celebrity, Andrea Mitchell, a church secretary and lifelong resident of New York’s 19th District, went viral too.

Mitchell attended a health care rally outside the home of Rep. John Faso in Kinderhook in January 2017. Someone filmed Mitchell confronting her congressman.

“I have a brain tumor and a spinal condition. And when I was first diagnosed I was kicked off my insurance because pre-existing conditions were out,” Mitchell said. “I need you as a human being to say, ‘I promise that we will not take this away from you.’”

Faso then hugged Mitchell and said, “I promise, I promise, I promise.”

Months later, like McSally, Faso voted in favor of the AHCA.

The video has haunted Faso in television ads by House Majority PAC and the Democratic Congressional Campaign Committee.

Faso faces a tough re-election challenge from Antonio Delgado in a race that Inside Elections rates Tilts Democratic.

Democrats echo Mitchell when they argue that Faso broke his promise to her.

Mitchell said that while she had once been private about her health conditions, she’s become an outspoken and candid advocate for the ACA in the months since.

“Speaking publicly about your health puts you in a vulnerable position. It can be very scary,” she said. But when people began recognizing her from the video and sharing with her their own concerns about losing health care, “that’s when I decided I was going to be a more public figure and speak more loudly and with more conviction.”

She’s become central to a race that in many ways encapsulates the fight about pre-existing conditions being waged in competitive districts across the country — so much so that Faso calls her out by name on his campaign’s official website. The campaign even links to her Twitter page, where she has about 200 followers.

Under the header “Andrea Mitchell,” the campaign states that “Antonio Delgado and Nancy Pelosi have … repeatedly attacked John Faso with a false claim that John Faso broke his promise to a constituent.”

Republicans tying Democratic opponents to Pelosi is a well-worn tactic, but invoking Pelosi when discussing a constituent is unusual.

Mitchell speculated that Faso campaign wants to associate her with an often “villainized” politician in order to make her seem dishonest and out of step with the district.

“It’s ridiculous,” Mitchell said. “I’m sure Nancy Pelosi has never heard of me.”

The Faso campaign makes the case that since Mitchell is covered under Medicaid, which cannot discriminate based on preexisting conditions, no promise was broken.

The Congressional Budget Office estimated millions of Medicaid patients would have lost coverage under the House GOP health proposal. The bill would have slashed Medicaid spending in part by fundamentally restructuring the program with per capita caps per enrollee. 

The Faso campaign asserts that even if the AHCA had passed, there is no way Mitchell would have been booted from Medicaid and left vulnerable to discrimination by medical underwriting, pointing to the generosity of New York’s program and statewide laws prohibiting such discrimination.

“Attacks from the left have relied on copy and paste talking points that ignore the realities of New York State law and Medicaid,” said Faso spokesman Joe Gierut. “The millions of dollars in misleading or downright false attack ads ignore the facts.”

However, even conservative health care experts say that’s hard to say for sure.

On Twitter, Mitchell wrote that “ANY bill that cuts Medicaid puts my healthcare at risk.” She challenges anyone who clicked through from Faso’s site to “please find the lie.”

I cannot be happier that the Faso campaign used this tweet on their official website to try to prove me wrong about cuts to the Medicaid expansion and the harm the AHCA would do to #ny19 Please find the lie.

— Andrea Mitchell (@she_fights_evil) October 10, 2018

Laura Packard

Laura Packard, an independent political consultant and cancer survivor, was traveling on a bus with other Protect Our Care activists when she noticed that a statement issued by her senator, Republican Dean Heller, alluded to her.

Packard first came into public view as a frequent antagonist of Donald Trump on Twitter. In April 2017, Packard was diagnosed with stage 4 Hodgkins lymphoma. Feeling a new sense of urgency, she ramped up her advocacy.

“I decided back in April, after I was diagnosed and after I learned that I would probably survive this, to be public because cancer isn’t something to be ashamed of,” she explained in an article in Campaigns & Elections. “Around the same time, the fight to end Obamacare geared up, then geared up again.”

Like Jeans and Mitchell, Packard starred in a viral video. In December of that year, she asked Heller at an event in Las Vegas why he would vote to repeal the ACA. “Without it I will die,” Packard said forcefully.

Packard, now in remission, has become a thorn in Heller’s side on Twitter and at protests and rallies.

Last month, Heller’s opponent Jacky Rosen rolled out an ad featuring Packard hitting the incumbent on the issue of pre-existing conditions. A last-ditch effort to repeal the ACA championed by Heller would have jeopardized those protections, Kaiser Health News reported.

Sen. Heller faces a tough reelection: Inside Elections rates the race a Toss-up.

Heller released a statement in response to the ad referring to Packard as a “Democrat operative” in the first sentence, and included a link to her professional website.

Packard described the statement as personal attack.

“I had to go through 6 months of chemotherapy and a month of radiation while fighting MY OWN Senator to keep my care,” she tweeted.

Why is my U.S. Senator, @SenDeanHeller, attacking me personally? Last year I was diagnosed with stage 4 cancer. I had to go through 6 months of chemotherapy and a month of radiation while fighting MY OWN Senator to keep my care. pic.twitter.com/H6FWVptsEz

— Laura Packard (@lpackard) October 8, 2018

Heller “is trying to intimidate me,” Packard said in an interview. “He’s talking to his base. He has no answer for his tax cuts to billionaires and taking health care away from millions of people so he’s attacking the people who would have suffered from his decisions.”

The Heller campaign declined to explain on the record its claim that Packard is a Democratic operative.

Packard serves as a consultant to progressive causes and Democratic campaigns, but says she hasn’t done paid work in Nevada for years. She currently consults for Protect Our Care.

Protect Our Care says it serves as a “dedicated war room for the ACA,” but it’s structured as a branch of the Sixteen Thirty Fund, a 501(c)(4) that does not disclose its donors, public records show.

In another election cycle, Heller’s dismissal of Packard as a partisan might not have made waves. But polls show health care is a top-of-mind issue heading into Election Day, especially protections for pre-existing conditions, and Packard’s story of fearing the loss of her health care coverage as she battled cancer has resonated online. 

“Insurance companies will cut you off or deny coverage if there are no laws protecting you,” Packard said. “They’re a for-profit business and it’s not profitable to provide care for someone with a lot of medical needs.”

Republican operatives have alleged that Packard worked as a tracker at Heller events last year. Packard said that allegation is untrue.

Packard said that she was treated for cancer with chemotherapy for six months beginning in May of last year, which deteriorates the immune system. She described the claim that a person could simultaneously work as a tracker as “weird.”

“Pretty much I only left the house last year during treatment to see doctors, get groceries, or to speak at events and protests,” Packard said. “Going around the state into masses of people in a fragile medical state is just a dumb idea.”

Harrington expressed dismay at Heller’s campaign for its response to Packard’s advocacy.

“Laura Packard is a young woman who experienced one of the most unimaginably horrible things a person can experience when she walked into a doctor’s appointment thinking she had bronchitis and walked out with a cancer diagnosis,” she said. “Whatever her vocation, if you can’t see her humanity from day one, and see her as the constituent of [Heller’s] that she is, that’s really appalling.”