Regardless of who wins the election, the ACA's fate is back in the hands of the U.S. Supreme Court

Yesterday, Donald Trump made it official: he is asking the U.S. Supreme Court to strike down the Affordable Care Act in its entirety.  A U.S. District judge in Texas had struck down the ACA, using as its justification the Republican tax law that removed the “mandate” which required all people to have insurance or pay what was essentially a “fine” to help defray medical costs of being deliberately uninsured. It isn’t clear why the ACA would be “invalidated” by the removal of the mandate, but it is clear that partisan politics is at its core. Texas still has the highest uninsured rate in the country, and in the past it has supported the use of so-called “mini-medical” plans that are regarded as scams in other states—ones that only pay a small initial lump sum and force the “insured” to be responsible for the rest. 

The “wildcard” in the Supreme Court is of course Chief Justice John Roberts, whose vote allowed the ACA to proceed in first place. A decision is unlikely to occur before the election, which Trump is banking on. His “base” support obliviously opposes anything with Barack Obama’s name on it, but I suspect that many voters who have grown accustomed to the ACA don’t really believe that the Supreme Court will really overturn it—or at least it hasn’t hit them that there is the possibility that it will. Democrats will surely make the possibility an issue during the election, but what will happen even if Joe Biden wins the election? Now that the case is officially in the Supreme Court’s “court,” there is little to be done until a decision is made, and perhaps even less that can be done if the law is struck down.

Last week the acting head of DHS, Chad Wolf, claimed that DACA was still “illegal” despite the Supreme Court’s recent decision rejecting the Trump administration’s rationale for ending it, and further claimed that the “American People” had not yet spoken on the issue. Polling, of course, says otherwise; nearly four-in-five Americans support DACA, even a majority of Republicans. But Trump continues to hear only a tiny, but highly vocal and hate-filled minority whose chief “spokesperson” is Fox News. In regard to the ACA, while support has often dipped below a plurality in the past, the closer to this election, the more voters have been concerned; a poll quoted in Forbes in February indicated that 55 percent of Americans supported the ACA, and the Kaiser Foundation’s recent polling continues to show that a majority of Americans favor the continuation of the ACA.

According to Kaiser, polling shows that “more Democrats and Democratic-leaning independents would prefer voting for a candidate who wants to build on the ACA in order to expand coverage and reduce costs rather than replace the ACA with a national Medicare-for-all plan. Additionally, KFF polling has found broader public support for more incremental changes to expand the public health insurance program in this country including proposals that expand the role of public programs like Medicare and Medicaid. And while partisans are divided on a Medicare-for-all national health plan, there is robust support among Democrats, and even support among over four in ten Republicans, for a government-run health plan, sometimes called a public option. Notably, the public does not perceive major differences in how a public option or a Medicare-for-all plan would impact taxes and personal health care costs.”

Remember that former Speaker of the House supported the gutting of the Medicare, and that despite claims that he would not touch Medicare in 2016, Trump has included cuts in Medicare in his budget proposals. Republicans showed themselves incapable of passing a health care plan of their own even when they only needed a simple majority in the U.S. Senate. Republicans continuing to misread the majority of public’s desire for some kind of national health care program that covers them when no other affordable option is available.  But once more, Republicans are the slave not to the public’s interest, but to those of a minority of hate-filled fanatics who oppose the ACA even though it is in their long-term interest to support it, or any other “public option.”