WASHINGTON - For almost four years, Sen. Bob Casey, D-Pa., had told anyone who will listen - sometimes smaller audiences than he would prefer - that he believes the Affordable Care Act faces existential threats. President Donald Trump and Republicans in Congress, he warned, have attempted to repeal the decade-old health law and chipped away at its coverage and consumer protections.
After the death of U.S. Supreme Court Justice Ruth Bader Ginsburg on Sept. 18, Casey suddenly found national attention on his biggest issue as Democrats scramble to illustrate to voters, in the final five-week stretch of the 2020 campaign, the dangers of a third Trump nominee confirmed, which would mean a 6-3 conservative majority on the high court.
In Pennsylvania, Casey, a top supporter of former Vice President Joe Biden's presidential campaign, will deliver a message of imminent doom: One week after Election Day, the Supreme Court will hear a lawsuit, backed by the Trump administration, that seeks to vacate the ACA entirely.
The Supreme Court nominee "will be the deciding vote on health care," Casey said in an interview last week, noting 1 million Pennsylvanians have gained health coverage and 5.5 million have preexisting conditions protected by the law. "These are big stakes."
Trump and Senate Republicans, meanwhile, have moved forward to replace Justice Ginsburg, who was one of the five justices to uphold the ACA in a 2012 Supreme Court decision. On Saturday, Trump named Judge Amy Coney Barrett as his nominee to the court.
Yet Trump also has sought to show he cares about at least one provision in the ACA: On Thursday, he announced a series of executive actions on health care, including one that promised to safeguard insurance protections should the Supreme Court undercut the law.
But that action was largely symbolic. The administration would have to work with Congress to come up with replacement protections if the law is struck down.
BELOW THE RADAR
The case before the Supreme Court originated as a legal challenge that flew below the radar in Washington and elsewhere.
The lawsuit dredged up years-old arguments over the ACA's individual mandate, the financial penalty the law required Americans to pay when they refused to buy health insurance.