On health care, voters in 2020 face an easy choice

American voters face a decision this election season between starkly different policies on nearly every issue. But, on one issue in particular, that choice could not be more stark. When it comes to ensuring access to affordable health care, voters are being asked to select between those who wish to protect and expand that access and those who want to dismantle it.

When Democrats enacted the Affordable Care Act 10 years ago, our reforms made it possible for more than 20 million more Americans to access health coverage and slowed the growth in health care costs to a level unseen in half a century. We enabled states to expand Medicaid eligibility, helping more low-income families get covered for the first time. Perhaps most importantly, we made it illegal to deny coverage to those with preexisting conditions like asthma, diabetes, heart disease and cancer. After winning the 2018 midterm elections on a promise to expand and strengthen the Affordable Care Act, we passed legislation to encourage more states to expand Medicaid, ban junk plans that leave patients with higher bills, and make coverage more affordable for at least 13 million more Americans.

Republicans, however, went to war against the Affordable Care Act from day one. They tried to repeal or undermine it more than 65 times in Congress but failed because they could not offer a replacement plan that would protect Americans’ access to affordable care and offer the same benefits and cost savings. Instead, they’ve adopted a strategy of saying what Americans want to hear on health care while doing the opposite.

When he ran in 2016 on a platform of overturning the Affordable Care Act, President Trump promised that he would replace it with a secret plan that was “much less expensive and much better.” When congressional Republicans unveiled their legislation in 2017, that secret plan was revealed: simply turn off most of the reforms included in the Affordable Care Act and turn the clock back to 2010. If you got sick, under their proposal, you were on your own. It quickly became clear that the Republican proposal would be far more expensive and far worse for Americans, reducing the rate of coverage instead of raising it. President Trump and Republicans spent months trying to repeal the Affordable Care Act and, unsurprisingly, failed. That’s because it remains broadly popular as it protects Americans’ access to high-quality and affordable health care. Indeed, over the past four years, President Trump has not offered a plan at all that would achieve his campaign promise on health care.

Having failed to undo our health care reforms through legislation, President Trump and Republicans turned to the courts. Right now, as millions of Americans are casting votes to determine the future of health care access in our country, the Supreme Court is preparing to hear oral arguments in a lawsuit by Republican-led states to overturn the Affordable Care Act. The Trump administration made the unusual decision to join the states’ lawsuit and refuse to defend federal law in court.

If their case is successful, the entirety of the Affordable Care Act could be eliminated, including its protections for those with preexisting conditions, its annual and lifetime coverage caps, its coverage for those under age 26 on a parent’s plan, and its preventive screenings with no out-of-pocket costs. Millions would immediately lose their Medicaid eligibility or lose access to the plans that cover them through a state or federal health care marketplace. Women could once again be charged higher premiums than men for the same plan, and older Americans could be forced to pay more.

It is no surprise, then, that Senate Republicans are breaking their own rules in a rush to confirm a Supreme Court nominee who has been outspoken in her view that the Affordable Care Act should have been struck down years ago. Having lost in Congress, they are now trying to stack the Supreme Court with a majority committed to their agenda of taking health care access away from Americans. While Republicans refuse to let voters have their say before confirming this Supreme Court nominee, voters still have a chance to protect health care access by electing Joe Biden and a Democratic Congress that is committed to safeguarding the tenets of the Affordable Care Act and ensuring that Americans’ access to quality, affordable health care will be preserved and strengthened.

The question of the future of health care policy in our country is made even more critical by the COVID-19 pandemic, which has exposed many of the deep-seated racial and income disparities in health care access and outcomes in our country. Ensuring that every American can access quality and affordable care is essential not only to overcoming this pandemic but eliminating these disparities, which include the unacceptable and deadly disparities in Black maternal health. Democrats are committed to tackling these disparities with the same energy and focus that we brought to our successful effort over the past two years passing legislation through the House to lower the cost of prescription drugs, strengthening the Affordable Care Act, and funding research for COVID-19 vaccines and treatments.

Americans must not be fooled again by Republican lip service on health care and preexisting conditions. As the old adage says: “fool me once, shame on you — fool me twice, shame on me.” Voters ought to judge both sides not by what they say but by what they have done. We must elect leaders with a proven record of standing up for quality, affordable health care for all Americans. The case for electing Democrats to protect and build on the Affordable Care Act is clear.

Hoyer is House majority leader.