From Affordable Care Act to COVID-19, Texans’ health care is on the ballot this year

The death of Supreme Court Justice Ruth Bader Ginsburg has unleashed an intense fight about choosing her successor. The stakes could not be higher, considering the issues the court will be ruling on. One of those issues is health care.

The court will hear a challenge to the Affordable Care Act brought by Texas Attorney General Ken Paxton. If Paxton is successful, the law will be overturned. The Health Insurance Marketplace, through which 8.3 million Americans received health coverage this year, will be wiped out. Insurance companies will no longer have to allow young adults to remain on their parents’ plans until age 26. Zero-dollar co-payments for essential health services will be a thing of the past.

And, most ominously, there will no longer be protections for the roughly half of Americans who have a pre-existing condition.

Before the ACA, Americans were charged more or denied coverage altogether for having a history of cancer, hypertension, diabetes and more. And what of the almost 7 million Americans who have had COVID-19? With reports of lung-scarring and heart damage, is it a stretch to think that the virus will be considered a pre-existing condition for denying coverage if Paxton is successful?

Unfortunately, Paxton’s position is clearly in the mainstream of the Republican Party. The Trump administration has joined forces with Paxton in this lawsuit, as have 19 other Republican state attorneys general. Gov. Greg Abbott and other Texas Republicans have been silent on Paxton’s suit and loud in their opposition to the ACA.

Given all this, health care is certainly on the ballot in this year’s federal elections. For Texans, it is also key to state legislative races.

In 2019, House Democrats proposed an amendment to the state budget to expand Medicaid and make health coverage available to more than 1.5 million Texans; due to COVID-19, even more would be eligible. With the largest uninsured population of any state in the nation, Texas has the most to gain from expansion.

Unfortunately, every House Republican voted against expanding health care access, denying millions the health care they would have if they lived in any of 38 other states. Republicans were following the lead of Abbott, who could single-handedly direct the Health and Human Services Commission to apply for a waiver to expand Medicaid.

Many states with Republican governors have expanded Medicaid because it is the right thing to do. The coverage helps people have longer and healthier lives. It also creates jobs, grows the economy and brings in $10 billion per year from the federal government.

Yet in Texas, where about one in four adults lack coverage, Abbott does nothing. His inaction comes at an enormous cost to our state. Treatable conditions go untreated. Chronic illnesses go unmanaged. Nonemergency conditions are addressed in the emergency room — the most expensive form of health care in the world.

As a result, hospitals struggle with the volume of care for which they are not paid. Those with private insurance pay higher premiums to subsidize the uninsured. Our property taxes rise to cover the gap. And the loss of productivity to preventable illness is a needless drag on our economy.

The COVID-19 pandemic has further exposed and worsened the Texas health care crisis. The next Legislature must take action to expand coverage. If it is up to Democrats, that is what we will do. We already know the decision Republicans will make on expansion, because they have made it repeatedly: they will say “no.”

So, when you vote, remember: Health care is on the ballot.