It seems like ages ago now, but just a few months ago Democrats were engaged in an intense and often bitter argument about precisely what kind of health-care reform the federal government should undertake if a Democratic president and Congress are elected this November. Lately most Americans have been far too consumed with the pandemic and the recession to think about reform that might or might happen in the future — which is just fine with Republicans.

But they won’t be able to keep the issue out of people’s minds for long. Two things will put it back on the agenda. First, as we approach November, Democrats all over the country will be airing ads and sending out mailers about health care, most of which will focus not on the nuances of reform but on the villainy of the GOP.

And second, the issue could come back to the Supreme Court just before the election, casting a new light on the destruction Republicans are trying to bring down on the American health-care system.

This is, to put mildly, not an opportune time for a party to be arguing for tossing 20 million or so people off their health coverage, eliminating protections for preexisting conditions, and throwing the entire health-care system into chaos.

But that is what the GOP advocates: The latest of Republicans' many lawsuits against the Affordable Care Act seeks to have the entire law struck down, which would not only obliterate an entire regulatory structure with nothing to replace it but would also snatch coverage away from all those who benefited from the expansion of Medicaid and take away subsidies that help those on the individual market afford private coverage.

And incredibly, a decade after they made “repeal and replace” their health-care mantra, Republicans still have no replacement plan.

As the New York Times reports, the issue is poised to come back onto the agenda, which is just about the last thing vulnerable Republicans want:

Republicans are increasingly worried that their decade-long push to repeal the Affordable Care Act will hurt them in the November elections, as coronavirus cases spike around the country and millions of Americans who have lost jobs during the pandemic lose their health coverage as well.
The issue will come into sharp focus this week, when the White House is expected to file legal briefs asking the Supreme Court to put an end to the program, popularly known as Obamacare. Speaker Nancy Pelosi, seizing on the moment, will unveil a Democratic bill to lower the cost of health care, with a vote scheduled for next week in the House.

Back in May, Attorney General William Barr, showing a brief flash of political pragmatism, advised the president that the administration might want to modify its support for the lawsuit, brought by a group of Republican states, that seeks to have the ACA torn out root and branch. President Trump said no, insisting that full repeal must be the administration’s position.

That lawsuit will be heard by the Supreme Court sometime in the fall. Although the decision probably won’t come until next year, shortly before the election we could have dramatic oral arguments in which Republicans publicly defend their plan to eviscerate the health-care system and throw millions off their coverage, while Democrats argue for maintaining the somewhat shaky protections Americans now enjoy.

You can see why Republicans are getting worried.

Even before the pandemic hit, the administration was working to take away as many people’s health coverage as possible, by undercutting Medicaid, trying to scare immigrants away from signing up for benefits they’re eligible for, and any number of other little-noticed policy changes. In a move that was unusually cruel even for this cruelest of administrations, officials even sought to make it easier to discriminate against transgender Americans in health care.

And now, the pandemic has underscored how vulnerable so many Americans are. In May, the Kaiser Family Foundation estimated that 27 million Americans could lose employer-based coverage as a consequence of the pandemic and the suspension of economic activity; while many were able to scramble to find alternative coverage, anxiety around health care is as high as it has ever been.

I would argue that this moment creates an opportunity for real reform, even of some kinds that weren’t being widely discussed when Democratic candidates were having this debate during the primaries. In particular, the fact that most of us get coverage through our employers is an accident of history that we could and should do away with, since it makes us so much more vulnerable to sudden shocks, whether personal (losing your job) or national (a pandemic).

The truth is that Democrats have long been skittish about ambitious health-care reform — they’d like to do it, but they’re always worried that it will be too difficult and the voters will punish them for it. I’m sure Joe Biden feels that way. Nevertheless, the plan he put out last July is radically progressive compared with the ACA itself, even if, as he often does, he was simply finding the center point within the Democratic Party. It’s just that that center point had moved left, so he was proposing something that sounded moderate.

While there’s no question Biden will set health-care reform in motion if he becomes president, we have no idea how hard he’s willing to fight or where he’ll compromise. But right now, nobody is talking about the details of his plan.

The reality is that from now until November, there will be a stark contrast: Republicans are trying to take away people’s health care, and Democrats aren’t. The president may spit up the occasional hairball of an attack about how Democrats are trying to create “socialism,” but he can’t divert attention from that simple binary.

It might have been different if Trump had told his allies to drop the lawsuit, or even come up with an alternative for reform. But it’s clear that he and his party were never going to be capable of doing something constructive on health care. And now they’re going to pay the price.

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