There is only 1 way to be certain the ACA remains the law of the land. Biden wins for president, Democrats win the Senate & hold the House.

In the aftermath of the loss of Justice Ginsberg, talking to Supreme Court lawyers & legal experts. Thread coming. Follow if interested.

A conservative justice to replace RBG would be devastating to voting rights, to money in politics, to rights for minorities & to reproductive health for women.

But the most immediate impact would be to the Affordable Care Act and what it means to Americans who need medical care.

Elimination of the ACA means:
-A loss of all the rules that makes insurance worth anything to you
-Anybody with a prior illness no longer has guaranteed access to insurance
-If you've had COVID, that means coverage for virtually every organ system not covered

-Heart attack, stroke, high blood pressure, kidney problems, mental health issues-- would all be pre-existing conditions
-20 million people would lose coverage, including many low income people
-Hospitals would shut, bankruptcies would increase, rx drug costs for seniors go up

The case has so many problems, but you should assume whoever is nominated to fill RBG's seat, if they hear the case, would be in effect interviewing for the case.

And the list of 40 people on Trump's list includes noted humanitarians like Tom Cotton, Josh Hawley and Ted Cruz.

Not just politicians, but people who could sit on the court for decades.

You will hear many many scenarios: 4-4 ties, partial verdicts, the case being pushed back to the District Court & yes, a possible conservative upholding the ACA. But there are a couple big questions,

1. Does Trump want a vote before the election?

I know his tweet says yes. But he has to act like he wants it. He's down 7 points in the polls. This pick is a big motivator for his base. Naming someone & then blaming Democrats for stalling juices the polls for him.

This puts the stakes very high. It is entirely possible that Democrats can put other procedural roadblocks to slow a vote down. It is also possible that several Republican Senators delay for either principled reasons (Romney, Murkowski) or political ones (Collins).

McConnell and Trump might not fight so hard against that scenario.

If the case is heard November 10th with 8 Justices, Roberts can always decide to hear it again with aa 9th. If it is heard with 8, ACA needs 5 to have a clean win.

2. Is there another conservative vote for the ACA, presuming Roberts is 1?

Maybe. But I wouldn't want to bet millions of lives on it.

3. Do the Democrats have recourse?

Like adding more Justices to the court or some other tact? Maybe, but only if they control the Senate and the White House. And even then, that's not a scenario one could bet on, or would necessarily impact this case.

4. If the ACA falls, is there a chance at a replacement bill?

With Trump in the White House and a GOP Senate, almost certainly not. One thing that happens in this case is the money that pays for ACA subsidies and Medicaid expansion become a giant tax cut.

In that case, Republicans won't put forward anything with close to the amount that would return coverage to people. They would put forward a thin sham bill to get Democrats to vote against it and say they had discharged their duties.

Only in a Democratic sweep is there likely to be a replacement bill using the reconciliation process. That way if the court does overturn the ACA, a replacement bill, including one with improvements would be able to be put forward.

Other scenarios are tenuous.

I never met Ruth Bader Ginsberg. I admired her like so many people. But from what I do know she would say "Mourn me for a day. Then get out there and work to fix this ."

There is a way. There is a way.