Actually, Issa's constituents are none too happy with him right now and are on top of policy. Issa won his district in November by 2000 votes. He was for repealing the ACA until his constituents skewered him, holding town hall after town hall where either Issa no-showed, or was harangued by angry voters.
But I agree there are a lot of people who would see an ad like this one and just believe the ACA was repealed.
I know _many_ Republicans, and yes, a concerted effort with ads like this would convince all of them that Obamacare was repealed. Even the ones that are on it. I'm not joking here.
a few takeaways - Trump had no interest in the policy details and made two huge mistakes while negotiating, Ryan completely blundered the bill's formation and the roll out, Bannon is a slimeball working both sides of the fence, and as an overall body the GOP is in deep trouble right now of their own making
These ads aren't unique to San Diego; I've seen a bunch of them where they change the last part (i.e. the part with the Congress Critter's name & picture) to reflect whatever district the ad is playing in.
The best one features Barbara Comstock because she was one of the moderates that flipped her vote to "No", which triggered Ryan to pull the bill. (Well, the moderates flipping were the final straw at any rate.)