COVID-19 has ravaged economies and devastated communities worldwide and has not spared the United States. Despite ample resources, biomedical advancements, and scientific expertise, the nation still ranks number 1 in the world for its number of reported cases. However, according to an assessment conducted by the Global Health Security Index, the U.S. received a top score of 85.5 of 100 possible points for its measured capacity to handle a pandemic. How is this contrast possible?

The “health system” portion of this assessment measures whether a country’s infrastructure to treat its sick and protect its workers is operating effectively. The U.S. received its lowest score of 73.8 of 100 possible points in this category. This highlights that a country’s capacity is insufficient if it is not adequately leveraged.

This pandemic has highlighted the severe misallocation of resources and inefficiency embedded in the U.S. system. The state of COVID-19 evinces a long-standing truth that America spends more on health care per capita than any nation, yet gets less health for it. With the pandemic ongoing, and the safety and wellbeing of our nation at stake, it is now more imperative than ever that the American medical system address the pervasive inequities. For this to be possible, effective political leadership is critical.

The Intersection of COVID-19 and the Affordable Care Act

COVID-19, and the economic downturn it caused, has undermined health insurance coverage. An unemployment surge, exceeding 20 million workers, has caused Americans to lose employer-sponsored insurance. This income loss, accompanied by strained employers curtailing coverage to cut costs, can only add to the estimated 40+ million underinsured before the pandemic. Medicaid enrollment increased by up to 4.9 million between February and July of 2020 alone. Yet, certain states’ refusal to take up Medicaid expansion, compounded by efforts to undermine the Affordable Care Act (ACA), left millions in other parts of the country uninsured and underinsured. These rates have grown as the pandemic has progressed, particularly among minority communities. A lack of coverage can lead those without insurance to forgo COVID-19 testing or treatment due to its unaffordability, hence worsening the nation’s crisis.

Some counterargue that the ACA has not adequately supported the working and middle-class—representing at least 40% of the population—and has not adequately improved the quality of care. However, a potential future decision to strike down the ACA in its entirety, during a pandemic, would eliminate existing Medicaid expansions, end protections for those with pre-existing conditions, remove the requirement that insurers let young adults remain on their parents’ plan until the age of 26, and eliminate the marketplace, premium tax credits, and cost-sharing reductions. The Urban Institute projected this would cause over 21 million people to lose coverage, increasing the uninsured rate by nearly 70%, particularly among low-income adults, minorities, the elderly, and young Americans during a time when coverage is most needed.

It is clear that weakening or overturning the ACA would worsen access to care and increase financial hardship nationwide at a time when accessibility is critical. This will only make the pandemic more devastating for our nation, with those who struggle to cover medical bills unable to afford necessities during an economic downturn. We should instead focus on bolstering and improving the existing law by extending more generous subsidies to more people and adding a public option to fill Medicaid coverage gaps.

On November 10th, the Supreme Court heard oral arguments for the third time challenging the ACA’s legality. By their questions, at least five judges suggested they would reject Republican attempts to strike the law down entirely, but a formal decision is yet to be made.

Georgia Paving the Way

It seems Georgia is proving itself a purple swing state, with record turnouts, particularly among young voters of color, in counties outside of Atlanta and through vote-by-mail. This shift in voting patterns could be indicative of a larger trend. On this morning after the Georgia runoff, it is looking like Democratic control of the Senate is within reach, which would help enact President-elect Joe Biden’s proposed ACA protections and expansions. These protections and expansions could not come at a better time.