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OPINION

Coronavirus crisis frames our election choice

Democrats want to protect and expand the ACA. Republicans want to roll it back.

Lesley Becker/Lesley Becker/Globe Staff; Adobe

To update Samuel Johnson’s 18th-century observation, knowing we’re all at risk of catching COVID-19 in the next fortnight or two should concentrate the national mind, particularly when it comes to health care policy.

The November election will present a stark choice. The Democratic Party is committed to protecting and expanding the Affordable Care Act, while the Republican Party hopes to deep-six the ACA, which would leave millions more Americans without coverage.

That choice will come at a time when, as Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, notes, millions will be out of work and left to rely on the ACA’s Medicaid expansion or the ACA marketplace (and subsidies) for their health care.

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“This will be the first economic downturn where the Affordable Care Act is there as a safety net for people who lose their jobs,” he says.

The Affordable Care Act was an attempt to address America’s health care problems in a way left, right, and the middle could agree on. That obviously didn’t happen. Although it’s built around a conservative idea — the individual mandate — the ACA drove conservatives around the bend. Repealing the law became an anti-Obama obsession. Meanwhile, though the ACA has largely done what it was designed to do, after some fits and starts, left-wingers still pine after single-payer.

The health care debate among Democrats, however, is virtually decided. They will go into the fall campaign behind a candidate who favors protecting the Affordable Care Act and improving it by adding a public option.

And the Republicans?

Until they have a concrete, detailed, vetted-by-experts plan of their own, it’s completely fair to judge the GOP by its past actions.

Start with President Trump. He will likely talk or tweet again about providing health care that’s “much less expensive and much better.” There, voters need to remember the old adage about getting gulled by a huckster: “Fool me once, shame on you; fool me twice, shame on me.”

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After all, as president, Trump has offered nothing of the kind. Instead, he and congressional Republicans pushed legislation that would have repealed the ACA, rolled back its Medicaid expansion, and then block-granted Medicaid and given the states more ability to restrict eligibility and benefits.

If Republicans had succeeded, somewhere between 15 million and 23 million more people would have been without coverage by 2026.

Thankfully, they failed. But the tax cut bill passed later in 2017 effectively eliminated the individual mandate. In response, a group of Republican state attorneys general and governors filed a legal challenge, arguing that that change rendered the entire law unconstitutional. Trump’s Department of Justice is supporting that effort to strike down the law. The Supreme Court will hear the GOP lawsuit in October — and likely decide it sometime next year, well after the election results are in. Although Trump has repeatedly promised to protect those with preexisting conditions, if the high court tosses out the ACA, those protections will vanish along with the law.

That means health care is on the line in the fall election. If the Democrats win, their victory should finally end any realistic threat that the law will be legislatively repealed. And if the Supreme Court strikes the ACA down thereafter, there will be a strenuous presidentially led effort to restore the law.

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If, on the other hand, Trump wins reelection and Republicans keep the Senate and win control of the House, repeal efforts will continue. But the ACA isn’t safe even if Democrats control both branches of Congress; if Trump is reelected and the high court overturns the ACA, Democrats would probably need to override a presidential veto to restore the law.

Are you one of the many millions who benefit from the ACA’s expanded Medicaid coverage, or its premium tax credits to help purchase coverage, or the protections against discrimination based on preexisting condition, or the prohibition on lifetime limits on coverage, or the ability to keep your kids on your plan until they are 26?

If so, you should vote as if whatever aspect of the law you depend on hangs in the balance in this election, because that may very well be true.


Scot Lehigh is a Globe columnist. He can be reached at scot.lehigh@globe.com. Follow him on Twitter @GlobeScotLehigh