The stats are scary: In the U.S., 50 percent of people fear bankruptcy due to major health event; one-fifth of non-white adults carry long-term medical debt that will not be repaid within 12 months; and one-quarter of U.S. adults must borrow money for a $500 medical bill [1] – which, if you’ve ever been to a doctor or hospital, you know is certainly not an outrageous bill to land in your mailbox.

Despite the historic passing of the Affordable Care Act in 2010, the health insurance system remains a major burden (at best) and a complicated, impossible maze of confusing coverage and surprise bills (at worst) for most Americans. The COVID-19 pandemic has made this system even worse, exposing the multiple cracks in the already tenuous system. Lockdowns in the early phases of COVID led to massive layoffs which in turn led to millions of people either losing their own employer-sponsored health care or the employer-sponsored health care of someone they depended upon. [2]

Though the ACA did expand coverage, create stronger protections for preexisting conditions, and helped control some health care costs – as well as give an estimated 20 million Americans access to health insurance the previously did not have [3] – justice requires that everyone has access to quality health care, something that is clearly still not happening.

Worse, with the confirmation of Amy Coney Barrett to the Supreme Court in 2020, the ACA and the health insurance coverage of millions, remains in a precarious state as more and more cases challenging the constitutionality of the ACA make the way up to the Supreme Court.

But there is a light. Last month, President Biden announced the nomination of Judge Ketanji Brown Jackson to the U.S. Supreme Court to fill the vacancy created by Justice Stephen Breyer’s retirement. Beyond a stellar career as a public defender and commissioner of the U.S. Sentencing Commission, an independent agency of the judicial branch of the federal government responsible for articulating Federal Sentencing Guidelines [4], Judge Jackson is also poised to make history as the first Black woman to sit on the Court and become only the seventh SCOTUS justice to have an identity that is not white and male. [5]

Though Judge Jackson’s history on cases regarding health care is slim, there are many things we can use to form logical speculations about how she may rule with regard to health care and the ACA.

First, as a Black woman with a career history as a public defender, Judge Jackson brings a combination of professional understanding and lived experience of a historically marginalized population to the Court. People of color have long faced significant disparities in health care coverage that directly impact disparities in health, something the ACA did help narrow. [6] And while it is of course impossible to predict how a justice might rule (which is the case with all justices) it is also safe to say that judgements and opinions do not exist in a vacuum and that the experiences, understandings, and unique perspectives of a justice do work to guide their possible rulings.

Beyond this, two cases with regards to reproductive rights, give clues into her thinking on health care access for all: she co-authored an amicus brief in support of a Massachusetts law creating a “buffer zone” around people as they approached abortion clinics [7] and ruled in 2018 against the Trump administration’s early termination of some federal grants under the Teen Pregnancy Prevention Program. [8] Both these point to a commitment to expanded and support health care – similar to ACA protections.

Finally, just last summer, Judge Jackson was part of a three-judge panel that allowed the Centers for Disease Control and Prevention’s pandemic-related eviction moratorium to continue [9] showing a clear understanding and possible willingness to disrupt the norms in favor of what is needed for the country, and to advance public health.

This, many say, is what we can most expect from Judge Jackson if confirmed to the Supreme Court: a judge who will question, “what the institution is doing and how it’s doing it, why it’s doing it, and whether that’s the best way to be doing things.” [10]

Of course, no one has a crystal ball to see the future – and no matter how many times my kid watches Encanto, we don’t have a Bruno prophecy to go on. But it would be downright silly to ignore the historic nomination and Judge Jackson and, as President Biden said at his confirmation announcement, the fact that her ascension to the Court would finally mean the court more fully reflected the full talents and greatness of the nation. [11]

As the nation continues to reckon with our unsustainable health care system, I look forward to seeing Judge Jackson’s thinking on how health care should be in the future.

Sources:

[1] https://news.gallup.com/poll/317948/fear-bankruptcy-due-major-health-event.aspx

[2] https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/

[3] https://www.washingtonpost.com/outlook/2020/10/16/obamacare-lawsuit-trump-barrett/

[4] [3] https://www.cnn.com/2022/02/25/politics/supreme-court-ketanji-brown-jackson/index.html

[5] [2] https://www.cnn.com/2020/09/25/politics/supreme-court-justice-minorities-history-trnd/index.html

[6] https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/

[7] https://casetext.com/case/mcguire-v-reilly-7

[8] https://www.courtlistener.com/opinion/4503408/healthy-futures-of-texas-v-department-of-health-and-human-services/

[9] https://www.washingtonpost.com/politics/2022/02/28/quick-guide-ketanji-brown-jackson-health-related-rulings/

[10 & 11] https://time.com/6151590/ketanji-brown-jackson-supreme-court-profile/