Fact-checking has been promoted as a key method for combating political misinformation. Comparing the spread of election-related misinformation narratives along with their relevant political fact-checks, this study provides the most comprehensive assessment to date of the real-world limitations faced by political fact-checking efforts. To examine barriers to impact, this study extends recent work from laboratory and experimental settings to the wider online information ecosystem present during the 2022 U.S. midterm elections. From analyses conducted within this context, we find that fact-checks as currently developed and distributed are severely inhibited in election contexts by constraints on their i. coverage, ii. speed, and, iii. reach. Specifically, we provide evidence that fewer than half of all prominent election-related misinformation narratives were fact-checked. Within the subset of fact-checked claims, we find that the median fact-check was released a full four days after the initial appearance of a narrative. Using network analysis to estimate user partisanship and dynamics of information spread, we additionally find evidence that fact-checks make up less than 1.2\% of narrative conversations and that even when shared, fact-checks are nearly always shared within,rather than between, partisan communities. Furthermore, we provide empirical evidence which runs contrary to the assumption that misinformation moderation is politically biased against the political right. In full, through this assessment of the real-world influence of political fact-checking efforts, our findings underscore how limitations in coverage, speed, and reach necessitate further examination of the potential use of fact-checks as the primary method for combating the spread of political misinformation.