President Donald Trump has long been opposed to the Affordable Care Act—and not even a global pandemic is going to change his mind. As his administration faced a Wednesday deadline to change their current position on the ACA’s fate before the question goes before the U.S. Supreme Court, Trump doubled down on his intention to see the health care law be abolished, even as others in his administration argue that’s not the smartest plan. “Obamacare is a disaster, but we’ve made it barely acceptable,” Trump told reporters Wednesday. “What we want to do is terminate it and give great health care.”
A coalition of Republican-led states have been arguing for the ACA to be rendered unconstitutional since 2018 (with multiple Democratic states defending the law in court), and the Supreme Court will hear the case during their next term. Though the Trump administration’s legal position in the case was first that the court should abolish only the health policy’s protections for preexisting conditions, it later changed positions and advocated for eliminating the ACA altogether. “We’re staying with the group,” Trump said Wednesday, telling reporters that the administration would not change its position again. But while Trump may be insistent that it’s time to burn the ACA to the ground, even some of his closest allies aren’t quite so sure. CNN reported Tuesday that U.S. Attorney General William Barr made a “last-minute push” to get the administration to back off their opposition to the ACA and modify its legal position for a second time, arguing that fighting the law could have “major political implications” for the administration in November if the ACA remains under threat—not to mention the danger of abolishing the law amid the coronavirus crisis. (HHS Secretary Alex Azar has also reportedly long opposed the administration’s legal stance.) And there’s certainly reason to believe that Barr’s political fears are founded. Though Republicans still remain largely opposed to the ACA, the health program is popular with a majority of Americans overall, with 55% supporting the law in a February Kaiser Family Foundation poll—the highest favorability number since the KFF began tracking it in 2010—and 52% supporting it in a March Gallup poll. The KFF poll also found that health care was voters’ most important issue in determining who they’d support for president, with 26% of total voters and 28% of swing voters rating it as their top issue.
Support for the ACA is sure to only increase in the face of the coronavirus, which has rendered the ACA and its individual health care marketplace more important than ever. On top of the 11.4 million Americans who already had ACA insurance in 2020 and 12.5 million enrolled in Medicaid expansion, the Economic Policy Institute estimated April 30 that approximately 12.7 million workers have so far lost their employer-based health insurance since the beginning of the pandemic alone. And those numbers could just be the tip of the iceberg, with the Urban Institute projecting that 25 million workers or more could ultimately lose their employer insurance due to unemployment caused by the COVID-19 crisis. Many of those workers are now likely to turn to ACA insurance or Medicaid, which was expanded under the ACA, potentially adding tens of millions to the number of Americans who would be affected by the Supreme Court’s decision. (The Trump administration, for its part, hasn’t done anything to help laid-off workers get health coverage more easily, refusing to call a special enrollment period for ACA insurance amid the coronavirus.)
While the health care law isn’t about to be struck down any time soon—the Supreme Court’s decision will likely come in spring 2021—new reports suggesting the coronavirus will likely be around for the next two years ensure that the ACA’s potential repeal would be felt by those suffering from COVID-19. “The only thing worse than a public health pandemic is a public health pandemic without health care,” Democratic strategist Jesse Ferguson told the Daily Beast in March. “It’s like watching the Chernobyl disaster and deciding to bulldoze the fallout shelters.” Tara Straw, a health care analyst at the Center for Budget and Policy Priorities, also pointed out to the Daily Beast that on top of kicking millions off their health insurance plans, repealing the ACA during the pandemic could shift more costs onto states whose budgets are already being decimated by COVID-19 struggles, as well as stymie the country’s economic recovery if people have to spend more of their income on health care costs. “Talk about compounding a crisis,” Straw said.