Competition for the hearts and minds of the voters in 2014 has begun with a bang—the opening salvo in the conservatives’ pre-election fight against Obamacare. This week, Americans for Prosperity, a group that espouses small government and is funded by the Koch Brothers, aimed directly at something near and dear to many Americans: the ability to choose their own doctors.

Choice became an issue way back in the 1990s, when the Clinton plan was kicking around, and more recently in the debate over the Affordable Care Act. Remember when the president said that if you liked your doctors with his plan you could keep them? So it’s not surprising that Americans for Prosperity would choose that as a theme for an anti-Obamacare TV commercial, which is running in Virginia and Ohio but soon to go national. Tim Phillips, president of Americans for Prosperity said, “Too often we fell into a broad-based ideological argument, and I think we failed to get at ‘Look at what they’re doing and how it impacts you.’” Sounds good, no? That’s what we’ve been preaching to journalists for some time, in fact, an honest look at how the thing works.

But on that score, the commercial fails. It is clever. It does contain a kernel of truth but overall it’s misleading and deceptive.

We hear from Julie, a young mother whose son started having seizures two years ago. She’s convincing and is every mother. The medical care he got “meant the world” to me, she says. (What mom wouldn’t say that if her kid got good treatment?)

Then comes the pitch—hardly subtle. Her brush with the health system prompted Julie to pay more attention, she tells us. “I have some questions about Obamacare. If we can’t pick our own doctor, how do I know my family’s going to get the medical care we need? Can I really trust the folks in Washington with my family’s health care? I think we all deserve some answers.”

Yes, we do. And a good place to start is setting the record straight about this ad.

Whether you can choose your doctor is a function of the insurance plan you have, not a function of Obamacare. While it’s true that Obamacare requires you to buy insurance, it does not say you can’t select who you want to treat you, as the ad implies.
Since the issue of doctor choice first surfaced years ago, changes in the insurance market that began well before anybody dreamed up the Affordable Care Act have meant that, in reality, millions of Americans are not always free to choose their physicians, a fact that made Obama’s remarks during the campaign somewhat disingenuous.

Over the past two decades, as insurers have increasingly selected networks of providers who give them the best discounts on the prices they charge for services, patients have not always had access to the doctors of their choice. If you go out of network to choose one you really want, insurers make you pay coinsurance and copayments and higher deductibles to do that. They make it financially advantageous to pick the doctors they’ve selected, even if there are problems with using them. One patient I recently met complained that her insurance plan allowed a limited choice of a pediatric specialist her daughter needed for a rare condition, and none was located near here home. Luckily, she said, she could switch insurers. For many, that’s not always possible.

As we’ve reported, this trend will continue under Obamacare, and apart from it, with insurers offering narrower and narrower networks to extract even higher discounts—all in an effort to keep premiums from going through the proverbial roof.

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.