[This post first appeared at BillMoyers.com on October 6, 2020.]
In 2018, health care was the major issue that swept Democrats into control of the House of Representatives. Still foremost among voters’ concerns today is protection for those with pre-existing medical conditions. Almost three-fourths of Americans favor preserving those protections, which the Affordable Care Act does.
So for four years, Donald Trump has lied about his commitment to keeping those protections in place. The truth is that at every turn, his administration has sought to eliminate them altogether. In fact, in a case set for oral argument before the US Supreme Court on November 10, the Trump administration is urging the Court to invalidate the entire ACA, including protections for pre-existing conditions.
Trump himself has a new pre-existing condition: COVID-19. So do several people who were in close proximity to him prior to his diagnosis, including (so far) his wife Melania, adviser Hope Hicks, press secretary Kayleigh McEnany and three of her assistants, former Gov. Chris Christie, campaign manager Bill Stepien, former counselor Kellyanne Conway, Sen. Mike Lee (R-UT), Sen. Thom Tillis (R-NC), personal assistant Nicholas Luna, Republican National Committee chair Ronna McDaniel, and University of Notre Dame President John Jenkins.
COVID-19: The Newest Pre-Existing Condition
Under the ACA, Americans with confirmed health problems “cannot be denied coverage, be charged significantly higher premiums, be subjected to an extended waiting period, or have their benefits curtailed by insurance companies,” according to the Centers for Medicare and Medicaid.
Even before the pandemic, as many as 133 million Americans under age 65 had at least one pre-existing medical condition. Today more than half of all Americans say that they or someone they know has one. Those conditions include but are not limited to cancer, diabetes, high blood pressure, high cholesterol, asthma, obesity, pregnancy, depression and other diagnosed mental and physical disorders.
But that was before February. Since then, an additional seven-and-a-half million Americans — including the president of the United States — have developed what is now a new pre-existing medical condition: COVID-19. And every day, 40,000 more are testing positive for the virus. To achieve “herd immunity” — which some members of the White House Coronavirus Task Force have pushed — 65 to 70 percent of a population has to become infected, according to the chief scientist for the World Health Organization.
That’s more than 200 million Americans.
The Cost of COVID: Calculating Health Care Premiums
It’s too early for experts to know the full scope of the pandemic’s damage to human health, but what they do know is profoundly disturbing. The list of prolonged problems is already significant, as is the increasing number of people who have them. Myocarditis, lung scarring, breathing problems, weakness, fatigue and blood clots have continued to cause trouble, even after minor cases of the disease have resolved. “Long haulers” are still suffering weeks or months after tests no longer detect the virus in them.
Many COVID-19 survivors, including some who are quite young, will require ongoing and wide-ranging types of medical care. Without the ACA, insurance companies will be free to resume using worst-case cost projections when setting premiums for anyone with a COVID-19 diagnosis. They will price millions of people out of the market.
Pre-Existing Opinions: The ACA and the New Supreme Court Justice
On September 24, two days before Trump announced Judge Amy Coney Barrett’s nomination publicly at a Rose Garden super-spreader event that featured no social distancing and few masks, he issued a legally meaningless Executive Order. It proclaimed that he supported affordable health care for those with pre-existing conditions. But by then, he had already offered Judge Barrett the US Supreme Court position, she had accepted and her hostility to the ACA was a matter of public record.
Judge Barrett’s overarching judicial philosophy follows that of her mentor, Justice Antonin Scalia, who co-authored a vigorous dissent in the seminal ACA case in which Chief Justice John Roberts sided with the liberal justices in a 5-4 decision upholding the law. In a January 2017 book review, Judge Barrett expressed her opposition to that decision: “Chief Justice Roberts pushed the Affordable Care Act beyond its plausible meaning to save the statute.”
Make no mistake: If Trump’s legal position prevails in the courts, the ACA and its protections for Americans with pre-existing conditions will disappear. Period. Because in the last four years, Trump and his fellow Republicans — including Sens. Lee and Tillis, who attended the Rose Garden super-spreader event and received a positive COVID-19 test result six days later — have failed to enact anything to take their place.
Save Your Health Care: Vote the Remedy
We, the people, who overwhelmingly favor health care for all Americans, have recourse. But the only thing that will preserve access to coverage is a pre-emptive strike by voters across the entire electoral field.
A Democratically controlled Congress, including the Senate, could send President Biden legislation to undo the damage that a Supreme Court ruling could inflict on Americans’ health care for years to come. The mission would be far easier for Biden to achieve than it was for President Obama because a vast majority of the public supports its key provisions, especially protection for those with pre-existing conditions.
US Supreme Court decisions have momentous implications for everyday lives. Few are as far reaching and personal as health care. But voters can still have the last word — provided they speak first in November.