The Supreme Court of the United States (Court) will hear oral arguments in California v. Texas – the landmark case that will determine the future of the Affordable Care Act (ACA) – on November 10 – a week after the election.
Naturally, the recent death of Justice Ruth Bader Ginsburg, has revived public interest in this issue and reestablished the future of the ACA in the forefront of the national health policy debate in the closing weeks of the 2020 campaign. President Trump has nominated Judge Amy Coney Barrett to fill the vacant seat, and if she is confirmed before the election, this would be one of the first cases she hears. If the seat remains vacant and the other eight justices hearing the case cannot reach a majority opinion, the lower court’s decision would stand.
While most observers still doubt the Court will choose to toss out the law entirely, it seems more likely that it will invalidate at least some portion of it.
If the Court ultimately strikes down part or all of the ACA, the next President and Congress will be under tremendous pressure to pass legislation to address those changes, most notably to continue its robust protections for individuals with pre-existing conditions.
President Trump says that he supports protecting those with pre-existing conditions, while also attempting to create new coverage options outside of the ACA, through association health plans and short-term health plans. Democrats, however, contend that the President has done little to act in favor of these policies. On September 24th, Trump also unveiled his “America First Healthcare Agenda,” which outlines the Administration’s actions to extend protections for those with preexisting conditions no matter the outcome of the Supreme Court ACA decision, expand coverage options, and end the practice of surprise billing.
Congressional Republicans, meanwhile, are largely taking a “wait and see” approach, pledging to act swiftly to address any changes to the ACA in response to the Court’s ruling but have stopped short of offering specific plans until it is known what changes would be needed.
Although Trump is currently polling ahead of Biden in terms of drug pricing policy, Biden is polling ahead of Trump on who voters trust more to handle the nation’s health care policy, according to recent polls conducted by Politico and Kaiser Family Foundation. Yet Biden’s health care aspirations could face a series of challenges, particularly if he is elected alongside a divided Congress.
With the fate of the ACA to be determined, Biden will use the campaign trail to fiercely defend the landmark health care legislation that he worked to enact during his tenure as Vice President. As part his health care agenda, Biden plans to build on the ACA by offering a new public insurance option that would compete with private insurance in the market. He will also argue that the COVID-19 pandemic demonstrates the need to retain health care protections under the current law rather than a replacement plan. Democrats in Congress will use their platforms to echo Biden’s messaging among their base and to challenge the Trump administration’s claims that it supports preserving coverage for preexisting conditions.