The Affordable Care Act (ACA), passed in 2010, was a massive overhaul to America’s broken health care system. The ACA expanded coverage, protected preexisting conditions, controlled health care costs, and, as President Obama stated when he signed it, was to enshrine “the core principle that everybody should have some basic security when it comes to their health care.”  It is estimated that more than 20 million Americans gained health insurance under the ACA. 
Since its passing, the ACA has been under attack and has been especially vulnerable under President Trump who has called for not only repealing the Affordable Care Act, but also cutting funding for Medicaid. 
The Senate is about to debate the confirmation of a new Supreme Court justice one week before the general election, both of which have the potential to change the trajectory of the country for generations. The Supreme Court is already scheduled to look at a case challenging the constitutionality of the Affordable Care Act just one week after the election. 
The case, which is scheduled for oral arguments on November 10, could disrupt health care coverage of tens of millions of Americans . The ACA prevents insurance companies from denying coverage to those with preexisting conditions. Prior to passage of the ACA, everything from allergies to multiple sclerosis could be factored into health insurance costs and coverage (along with a person’s height, weight, and how dangerous their job was). Insurers could, and often did, refuse to cover services like addiction treatment or pregnancy care.  Beyond that, cost remains a major factor with the Trump administration hawking cheaper insurance plans to desperate people who otherwise don’t have access to health insurance. These low-cost options do not adequately protect people if they develop serious illnesses, and leave them vulnerable to “astronomical costs.”  Furthermore, the COVID-19 pandemic has exposed the vulnerability of having health insurance coverage tied to employment. 
The case would also have major repercussions for reproductive rights. The ACA which requires health insurers to cover preventative health services such as mammograms, pap smears, and contraceptives including birth control at no out of pocket costs, and although there are exemptions that allow for religious discrimination by employers have denied this benefit for many people, the fact remains that there are also many who are covered. Health insurance plans are not able to charge extra for these services with co-pays or deductibles. 
Despite all the progress under the ACA, abortion remains an essential health service that is explicitly excluded from the list of ‘10 Essential Health Benefits’ all plans available through the ACA’s Marketplace are required to cover; no plan is required to cover abortion under federal law.  Abortion costs, and the additional fees for abortion care prevalent under both under private and public insurance coverage are a major restriction on par with mandatory ultrasounds, waiting periods, and time-based bans.  On top of that, the Trump administration is trying its best to make it even harder for those health insurance companies who do offer some form of abortion coverage to continue doing so by requiring unnecessary and confusing administrative hoops that, by their own account, would subject three million people to onerous, prohibitive regulations and could cause many insurance plans to drop abortion coverage all together. 
Despite favorable public opinion for a national health plan and a national health option being a major talking point among politicians and elected officials, the ACA currently remains the best way for many Americans to have access to health insurance. 
A week after the 2020 election, we will see if our work will be to expand the Affordable Care Act or protect it. The health and well-being of millions, in the midst of a deadly pandemic, hangs in the balance.