But this is more than a story about one case or even just this presidential campaign. It will set the stage for the next phase in our long national health care debate, a phase that will begin if Joe Biden becomes president and Democrats control Congress come January.
But this time, Republicans will not only have profoundly wounded their credibility, they will also have inadvertently helped Biden make the case for the reform he’ll propose.
The new brief that the Trump administration filed with the court on Thursday night left zero doubt that Trump wants the entire ACA to be torn out, root and branch — including its protections for preexisting conditions.
The administration brief argues that because the individual mandate has been rendered meaningless (in 2017, the GOP-controlled Congress reduced the penalty for not carrying insurance to $0), the other pillars of the law must be invalid.
Those pillars include the requirement that insurers cover everyone regardless of health status, and at comparable prices — which guarantees access to coverage for those with preexisting conditions.
Those pillars are invalid because the mandate was tied to them, the brief argues, adding that “it necessarily follows that the rest of the ACA must also fall.”
This is a legal argument that even ACA critics have dismissed as utter lunacy. But it unequivocally confirms an important principle: Democrats want to expand people’s access to health care, and Republicans want to take people’s health coverage away.
First let’s note that this brief deals a tremendous blow to the arguments that Trump and Senate Republicans are making in their campaigns.
For instance, note this new ad from GOP Sen. Martha McSally of Arizona, who is trailing in her reelection bid to astronaut Mark Kelly. In it, she states flatly: “Of course I will always protect those with preexisting conditions. Always."
PolitiFact rated this claim “false,” pointing to McSally votes that would have removed those protections.
But now Trump’s own administration has declared this as an unequivocal goal. Indeed, as James Hohmann details, this brief can now be used against numerous GOP Senators up for reelection.
Trump has undercut his own campaign arguments, too. He regularly vows to protect preexisting conditions, yet he has not offered any plan to do so, and now his brief lays his true intentions bare.
Indeed, Trump has provided Democrats with potent ammunition against him. The Democratic super PAC Priorities USA is out with new ads blasting Trump for trying to gut these protections for millions. One of the ads explicitly mentions his efforts before the Supreme Court.
Priorities USA tells us its research has identified 1 million voters in battleground states that are particularly susceptible to this sort of message about health care, and that this group of voters is younger and more diverse than its typical persuasion targets.
Now imagine that Biden and Democrats do win this fall’s elections. This would be the first presidential race that Democrats won since the ACA went into effect that turned heavily on the debate over the law’s future.
That would represent a 180-degree turn in our national health-care debate. In 2010, Republicans marshaled outrage over the ACA to win back the House and hamstring the Obama presidency, and while they lost the 2012 presidential election, they won the Senate partly on the issue in 2014.
But then, after 2016, when Republicans had total control of the White House and Congress, not only did their efforts at repeal fail in 2017; they went on to lose the House, largely over this issue, in the biggest midterm wipe out suffered by Republicans since the Watergate era.
Thanks to this lawsuit, if Biden wins, it will be even clearer that this was in part because of Trump/GOP efforts to destroy the ACA. In fact, arguments in this case will be heard this fall, when the campaign is on full boil. (A decision won’t come until next year.)
And so, while you should be skeptical about talk of “mandates,” this history will certainly embolden Democrats to forge ahead with the reform plan Biden ran on.
Biden’s plan creates an expansive public option open to anyone, including people who now get insurance from employers. It automatically signs up people who would have been eligible for Medicaid under the ACA’s Medicaid expansion but live in states that refused to accept it. And it auto-enrolls low-income people whenever they interact with the government.
Even if that’s not Medicare-for-all, it’s still a dramatic expansion of government insurance, one likely to enroll tens of millions of Americans.
So in 2021 you’ll have a convergence of factors pushing Biden’s reform: Democrats will be emboldened. We will still be dealing with the horrific effects of a pandemic that dramatically highlighted the need for far more comprehensive health coverage. And we’ll have fresh memories of a truly depraved GOP legacy of trying to strip coverage from millions — in the middle of that very pandemic.
All that is no guarantee of success, and Biden’s plan will meet fierce resistance. But the chances for substantial reform look about as good as they ever have, and Trump’s unhinged efforts may make them even better.