Sen. Cindy Hyde-Smith, a Republican from Mississippi and close ally of President Donald Trump, wants to repeal the Affordable Care Act. She has called the health reform the “worst thing that’s happened to us” and the “Democratic Party’s first step toward a full government takeover of healthcare.” As a senator, she voted to undermine protections for preexisting conditions multiple times.

This is a brazen reversal from her stance on health care not too long ago. Before getting elected to the Mississippi state Senate in 1999, Hyde-Smith spent five years as a lobbyist in Washington, D.C. For at least part of that time, she served as state director for Mississippi, Louisiana, and Tennessee for the National Coalition on Health Care, which spent the 1990s calling for universal health care coverage.

The National Coalition on Health Care was founded in 1990 by Dr. Henry Simmons to “help achieve comprehensive health system change.” According to its website, the group currently represents more than 80 unions, businesses, nonprofits, and pensions and health funds. In the 1990s, the coalition called for the creation of a public option to achieve universal health care coverage.

“Under the plan, every American would be guaranteed access to a defined, comprehensive package of health benefits,” the coalition wrote in a 1992 outline of their proposal. “People who are not otherwise insured would receive their insurance coverage and the same package of benefits through a mechanism that we call Pro-Health, which would incorporate the acute care portion of Medicaid.”

Shortly after Hyde-Smith left the coalition, the group’s senior policy analyst said it was a “national embarrassment” that the U.S. was the “only developed country besides South Africa that doesn’t have a national health insurance program.”

Hyde-Smith initially entered the state legislature as a Democrat before joining a wave of other local lawmakers in switching to the Republican Party in 2010. Even as a Republican lawmaker, Hyde-Smith produced a report in the legislature recommending that Mississippi do more to ask the government for the public money that the ACA made available, The Intercept previously reported. In Mississippi, the ACA provides health care coverage to about 100,000 residents and provides protection for preexisting conditions to about 600,000. Hyde-Smith’s campaign declined to comment on her previous work, but pointed The Intercept to a statement reiterating her commitment to repealing Obamacare.

While other vulnerable Republican senators have sought to distance themselves from the Trump administration’s efforts to repeal the ACA, Hyde-Smith is not wavering in her hostility to the health law.

Hyde-Smith is currently locked in a competitive race against Democrat Mike Espy, a former congressman and U.S. secretary of agriculture who’s made expanding Medicaid his top issue. “Mississippi ranks last in the nation for health care outcomes,” Espy tweeted. “The solution is obvious: Expand Medicaid. As your Health Care Senator, that is what I plan to do.” Hyde-Smith is also actively campaigning on the issue, dedicating her second campaign ad to health care. In the 30-second ad, she said she has brought more support to rural hospitals and worked to combat the coronavirus pandemic with additional funding for testing. (A 2019 report found that Mississippi has more rural hospitals at risk of closing than any other state.) She’s also among the GOP incumbents refusing to debate their opponents, which Espy slammed as “disrespecting the voters.”

On November 10, a week after the election, the Supreme Court is scheduled to hear arguments over whether the ACA should be dismantled. Hyde-Smith hopes the court sides with the president. Her Democratic opponent, meanwhile, wants to expand the ACA. Espy’s long-shot campaign saw a massive surge in fundraising and national support following the death of Justice Ruth Bader Ginsburg last month, which instantly stoked fears over the future of the ACA. Now, with two weeks to go, he is virtually tied with the GOP incumbent.

But while other vulnerable Republican senators have sought to distance themselves from the Trump administration’s efforts to repeal the ACA, Hyde-Smith is not wavering in her hostility to the health law. Republican senators facing tough reelections — including Martha McSally of Arizona, Joni Ernst of Iowa, Cory Gardner of Colorado, Dan Sullivan of Alaska, and Susan Collins of Maine — broke with the party earlier this month, joining Democrats in voting for a largely symbolic measure to protect the ACA and those with preexisting conditions from a Trump administration lawsuit. Hyde-Smith was not one of them.

Hyde-Smith touted her work with the National Coalition on Health Care in campaign ads throughout her 1999 state Senate bid. “As a Congressional Lobbyist in Washington D.C. Cindy has successfully led a national effort to address the problems of the health care system in America,” read one ad, which was published in the Enterprise-Journal. “Through her leadership with the National Coalition on Healthcare she was able to identify crucial deficiencies in the health care system and obtain practical goals and objectives to address those very serious issues.”

Another one of Hyde-Smith’s campaign ads, published in August 1999, declared that she “has already taken a stand and been the voice for many patients” and “will work to provide quality medical care and facilities to everyone.” The ad included an endorsement from a local doctor: “I encourage all healthcare professionals as well as patients and their families to support Cindy Hyde-Smith,” Dr. Braxter Irby said.

In a statement announcing the launch of her campaign, Hyde-Smith highlighted specific health care issues her work addressed, including “affordable insurance, access to medical care and the financial burden of prescription medications and medical bills our senior citizens face.”

But since she was first appointed to the U.S. Senate seat in early 2018 when longtime Sen. Thad Cochran retired because of health concerns, she has advocated for policies that would increase the number of uninsured people and undermine protections for preexisting conditions. And when it comes to universal health care, she rails against Medicare for All using the predictable GOP talking points, saying it’s a “government-run” health care program and a way to “make insurance illegal.”

Espy, who would be the state’s first Black senator since Reconstruction, ran a competitive campaign against Hyde-Smith last cycle but ultimately fell short, losing by about 8 percentage points in the runoff election.

He’s using the recent influx of campaign cash, a haul of more than $4 million last quarter, to massively outspend Hyde-Smith on political ads, dropping $1.01 million on television and radio ads compared to her $147,000. Democratic presidential nominee Joe Biden endorsed Espy last month, and national groups like the Democratic Senatorial Campaign Committee have also ramped up their support in recent weeks.