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Chris Van Hollen: Amy Coney Barrett is a threat to the Affordable Care Act | COMMENTARY

Supreme Court nominee Amy Coney Barrett Wednesday, Oct. 21, 2020, on Capitol Hill in Washington.
Supreme Court nominee Amy Coney Barrett Wednesday, Oct. 21, 2020, on Capitol Hill in Washington. (Anna Moneymaker/AP)

Xiomara is a lot like any other 6-year-old Marylander. She’s kind, clever and deeply curious about the world. But behind Xiomara’s smile is a hard-fought battle for survival. She was born with 10 different preexisting health conditions and before ever arriving home needed over $3 million dollars in health care services to stay alive. She now uses a tracheostomy tube, a ventilator, a feeding tube and a wheelchair. Despite the challenges, Xiomara is thriving and is as energetic as ever.

Last week, I spoke with Xiomara, her mother Elena, and two-time breast cancer survivor Jacqueline Beale to hear their health care journeys — the surgeries, the bills, the threat of hitting lifetime limits, and the deep uncertainty that comes with illness. They made one thing very clear: they need the Affordable Care Act (ACA). This law, while not perfect, has brought them and many other Marylanders peace of mind knowing they won’t be denied coverage or charged more because of preexisting conditions. And it’s not just that — the ACA’s elimination of annual and lifetime benefit caps keeps Ms. Beale and Xiomara from being kicked off their health care plans if they incur steep bills.

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But these and other safeguards may be stripped from Americans in mere months. At stake right now — both in the battle before the Supreme Court and in President Trump’s nomination of Amy Coney Barrett — is the direct health care coverage of over 20 million Americans and critical protections for 133 million with preexisting conditions.

This fight has real consequences. On our call, Ms. Beale wondered what a third cancer diagnosis would mean. Elena worried if she’d be able to afford the care that allows Xiomara an active life.

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These concerns appear to mean nothing to President Donald Trump and Congressional Republicans, who are obsessed with destroying the ACA, yet have put forward no real alternative.

Since taking office, Donald Trump has been hell-bent on dismantling the ACA without a backup. His plot: attack the Supreme Court’s previous decision to uphold the ACA and nominate justices to strike it down. He found a nominee who fit the bill in Ms. Coney Barrett, who, among other things, criticized Chief Justice Roberts' vote in support of the ACA.

On November 10, just one week after the election, the Supreme Court will hear a case brought by Republican state attorneys general and backed by President Trump and Attorney General Bill Barr to strike down the health care law. That’s why Senate Republicans have reversed course and now support confirming a nominee in an election year. This illegitimate process will mark the first time in history that a Supreme Court nominee has been considered this close to a presidential election.

The stakes could not be higher. There are 2.6 million Marylanders with preexisting conditions who could face higher costs and fewer benefits. And the pandemic only ups the ante. Over 135,000 Marylanders who have already been diagnosed with COVID-19 could face anemic coverage and steep premiums should preexisting condition protections be eliminated. Insurers could also be empowered to flat-out deny coverage to 1.1 million Marylanders who have health conditions considered “uninsurable.” Out-of-pocket expenses may soar, and more working families could go bankrupt trying to get care.

While Maryland has taken measures to try and curb the impacts of a possible repeal, much uncertainty remains. We simply have no way of predicting the Supreme Court’s decision — or its effect even with safeguards. What’s more, the state does not have jurisdiction over all health insurance plans. States don’t have the authority to regulate self-funded employer plans governed by the federal Employee Retirement Income Security Act (ERISA), so these enrollees would be hung out to dry. And, the elimination of federal dollars for Medicaid expansion and tax credits could cause serious funding challenges that threaten states' ability to maintain affordable coverage — an issue worsened by COVID-19 budgetary strains. Lastly, Maryland may have difficulty retaining insurers if other states do not hold companies to the same standards. These uncertainties could present serious challenges to Marylanders and their health coverage.

The GOP compulsion to slash protections for those with preexisting conditions is particularly disgraceful during this pandemic. This assault on health care would knock down Marylanders just as they’re trying to get back on their feet.

That’s why we must fight back and do everything we can to stop this abuse of power. Please contact your family and friends in states where senators are backing this illegitimate process and flawed nominee, and urge them to ask their senators to reconsider. It’s tough, but doable. In 2017, we were able — by a single vote — to stop the Senate from dismantling the ACA. Now, Senate Majority Leader Mitch McConnell and President Trump are trying to do through the Supreme Court what they failed to do through the democratic process. We must use every tool to protect Americans with preexisting conditions and the millions more who depend on the ACA.

For Xiomara, Jaqueline, and the 2.5 million Marylanders at risk of being charged more or denied coverage altogether, the risks are too high to sit this one out.

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Chris Van Hollen (assistance@vanhollen.senate.gov) is a U.S. Senator for Maryland and a member of the Senate Appropriations Committee.

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