How the Supreme Court vacancy could turn Florida presidential race into a fight over health care

The death of U.S. Supreme Court Justice Ruth Bader Ginsburg and the ensuing fight to replace her has thrust the future of health care in Florida into the spotlight during the closing weeks of a narrowing race for the White House in the Sunshine State.

With his third appointment to the high court, Republicans hope President Donald Trump can deliver the final blow to the Affordable Care Act after a decade of GOP efforts to dismantle the federal health care law. The Supreme Court is scheduled to revisit the law a week after Election Day in November.

But the timing of that case coupled with the vacancy created by Ginsburg’s passing has the potential to alter the political landscape in Florida, the country’s largest battleground and where more people purchase coverage through the Affordable Care Act than in any other state. Former Vice President Joe Biden and his Democratic allies have for months sought to frame the race here around the healthcare fight, and their case is much clearer with the Supreme Court down a justice who has repeatedly voted to uphold the law.

“For those Floridians, if they understand that Trump’s pick or his reelection means they lose their health care, that’s a game-changer,” said U.S. Rep. Kathy Castor, a Tampa Democrat. “Justice Ginsburg’s death is going to be a wake-up call when they hear that their health care weighs in the balance.”

Trump and Senate Republicans have ignored calls from Democrats to let the November winner pick the Supreme Court nominee. Trump said he expects to name a nominee on Friday or Saturday, a fact he will surely tease when he visits Jacksonville on Thursday. Meanwhile, Democrats are planning to emphasize the stakes of Trump’s selection on Floridians' health care when he comes to the state, said Frances Swanson, spokeswoman for the Florida Democratic Party.

The argument is one that Democrats have made for months in Florida, where 1.9 million people could lose their subsidized health insurance purchased through the Affordable Care Act and where the share of uninsured Floridians is on the rise as more people are without employer health insurance during the pandemic. Priorities USA, a Democratic-aligned Super PAC, has spent $18.5 million in Florida, much of it on ads centered on health care. In March, the Florida Democratic Party made Trump’s fight against the Affordable Care Act the focal point of a tour of the voter-rich Interstate 4 corridor.

But the judicial vacancy and the ongoing public health crisis have sharpened the attack. Biden on Sunday suggested that Trump’s end game would result in millions of Americans with pre-existing conditions losing health insurance once again. The Trump administration is supporting the lawsuit soon to come before the Supreme Court that argues the act should be overturned.

“And perhaps, most cruelly of all, if Donald Trump has his way, complications from COVID-19, like lung scarring and heart damage, could become the next deniable pre-existing condition,” Biden said.

In response, Trump’s campaign pointed to 20 statements where the president has said he would not let insurance companies boot people from their insurance if they have pre-existing conditions.

“President Trump understands his obligation as President is to fill the vacancy without delay,” said Emma Vaughn, the spokeswoman for the Trump campaign in Florida. “He has a proven record of selecting the most qualified individuals to uphold the Constitution and will do so again to allow the Court to continue serving the American people.”

Trump, though, hasn’t produced legislation to protect people with pre-existing conditions, despite repeated promises over the years to reveal a health care plan. In Melbourne just weeks after taking office in 2017, Trump told an audience “we are going to be submitting in a couple of weeks a great healthcare plan that’s going to take the place of the disaster known as Obamacare.” It didn’t happen.

Two years later, Trump told reporters that a group of senators, including Florida’s Rick Scott, were working on an Affordable Care Act replacement. That was news to Scott, and nothing materialized. In July, Trump told Fox News anchor Chris Wallace a plan was coming in two weeks. Again, he didn’t produce one.

"We’re going to be doing a health care plan very strongly and protect people with pre-existing conditions,” Trump said in an ABC town hall last week.

For years, Republicans operated on the offensive when it came to the Affordable Care Act, the signature domestic policy achievement of President Barack Obama’s eight years. They dubbed it “Obamacare” and turned it into a bogeyman that helped run Democrats out of power in the House and Senate.

But the law gained popularity the longer it stuck around. By the time Trump won election in 2016, Republicans couldn’t muster the political will to repeal it.

Two years later, Democrats ran on a promise to defend Obamacare, including in Florida. Donna Shalala and Debbie Mucarsel-Powell won hard-fought Congressional races in South Florida, home to the largest concentration of Obamacare recipients in the country, by embracing the law. U.S. Rep. Stephanie Murphy staved off a challenge for her purple Orlando-area seat where national Republicans came out of the gate criticizing her support for Obamacare.

“You can’t make the election just about Trump, you have to make it about what he stands for,” said Brad Howard, Murphy’s chief of staff. “In the suburban swing districts, the demographic campaigns are after right now, this is a very important issue, particularly for women.”

In a recent CBS News/YouGov poll of Florida, 84 percent of female respondents said health care was a major factor in their choice for president. Overall, 33 percent of those surveyed said Trump’s policies have helped make their health care more affordable, while 54 percent said they expected a Biden administration would.

Former U.S. Rep. David Jolly, who as a Republican voted to repeal the Affordable Care Act, isn’t sure voters will make the connection between the Supreme Court and their health care, especially if Trump and Senate Majority Leader Mitch McConnell push the nomination fight to a lame-duck session.

But Jolly, who has since left the GOP, said he expects the Supreme Court fight to change the enthusiasm calculation in the race.

“Where I see it definitely having an impact is on energy and mobilization,” Jolly said. “I think 2020 is all about, ‘Do you support Trump or not,’ but I do give credit to Democrats for trying to keep the focus on kitchen table issues.”

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