In the 2020 election, health care was listed as one of the most important issues to voters. The COVID-19 epidemic has further highlighted the myriad problems and deficiencies in our current health care system. Recent polling shows Medicare for All (or some sort of single-payer reform) is supported by 55% of voters, almost 7 in 10 support some sort of public option, and nearly 8 in 10 adults believe prescription drug costs are too high. Time and again voters have spoken that health care reform is critical to improving our way of life.

Even with this overwhelming support for reform, we have had to fight tooth and nail in each election to maintain what progress that has been made. The will of the people continues to be stymied by voter suppression, gerrymandering, and a political system that continues to give the minority of the population — frequently those with the most wealth and large corporate lobbies — more power than the majority.

We saw the impact of elections and our election system in 2016, when those who had worked for a decade to weaken and overturn the Affordable Care Act won the majority in Congress and almost succeeded in repealing the law. Just one single vote in the Senate is all that prevented the protections of the ACA from being taken away. In twelve states, elected officials continue to deny health care access to millions by refusing to expand Medicaid and legislating requirements that very few can meet to qualify for unexpanded Medicaid coverage.

Without meaningful protections and reforms to our election system, we must continue to remain on the defensive, as we have since the passage of the Affordable Care Act — the most impactful and significant health care legislation passed in close to 50 years. The fact is if we do not have free and fair access to the polls for each and every eligible voter, we can forget any meaningful health care reform in our near future. We can have the best legislation that would guarantee universal health care, but it will mean nothing if we cannot elect people who will pass it.

The 2020 election was historic in many ways, no more so than holding the record for the largest number of votes cast in an election in American history. Yet as soon as the last ballot was counted, it became clear that the strategy of those who supported the last administration — the same people who tried to repeal the Affordable Care Act — was to prevent such a large turnout from ever happening again. Through lawsuits and legislation, from the federal level to the county, conservative politicians have advanced new and undemocratic restrictions, chipping away and rolling back protections afforded Americans under the Voting Rights Act. Decades of gerrymandering have left us a situation in which districts have been drawn that minimize the votes of over one half of our country.

Further, the attacks on the idea of free and fair elections by the far right and supporters of former President Trump continue to undermine the confidence in what we have touted as the strongest democracy in the world. Elected officials preemptively questioning the outcome of elections, declaring fraud if they do not win, and perpetuating the idea that our voting system is rife with fraud are all endangering the future of our nation.

We are in serious danger of losing our representative democracy and with it the chance to further meaningful health care reform. This is not hyperbole. If members of a single political party are able to decree that those vote for their opponents are not eligible to vote, or make voting so difficult for huge swaths of our nation, particularly voters of color, low-income voters, those who need to vote by mail easily, those with disabilities, we will no longer have a representative government. When elected officials can choose who can and cannot vote, our democracy dies.

The idea of elected officials determining who can vote is not new, and this is far from the first time members of one political party have worked to undermine our Constitution and the rights it guarantees. But that doesn’t make it right and we cannot allow it to happen.

Following the Civil War and the assassination of President Lincoln, rights that had been confirmed by the 14th Amendment were undermined by his successor and white Southerners of the time. The implementation of Jim Crow laws, while still saying the right to vote existed for men of color (not women), prevented millions of Americans from determining their future and those of their children. Immediately following the Civil War, we had African Americans elected to state legislatures and Congress, but within a generation, that was no longer so.

The idea of representative democracy means that every vote matters. Black votes matter, women’s votes matter, Latinx votes matter, indigenous votes matter, immigrant votes matter, votes of the poor and disadvantaged matter, the votes of college students matter, the votes of disabled Americans matter — every vote matters. They should and we should make sure they do. We must make sure they do if we want a chance at a comprehensive health care system that everyone can afford and access.

The desperation of a minority to cling to power has never been more stark than with the release of the most recent census data. Many preliminary reports state that, for the first time, Caucasians are not the largest growing demographic in this country. The time of so-called minorities outnumbering or even equaling the number of those of European ancestry in the United States — or at least how they are counted — has arrived. And with it, those committed to the long-standing white male power structure they have worked so hard to maintain are more committed than ever to keep their power.

If we stand by as a growing minority in our nation, at the behest of outrageously wealthy benefactors, continue to rollback the hard won advancements that Americans have fought and died for, we will be abandoning the path towards that more perfect union, and turning our backs on the ideals of life, liberty and the pursuit of happiness for all. We will finally in fact be a nation where corporations and a small group of ideologues focused on acquiring all the wealth they can run roughshod over the majority of the population that they no longer represent. If they succeed in disenfranchising sizable blocks of the American electorate, we will be looking at the end of America as a nation with a representative government.

Equal voting rights are central to any other issue each of us holds dear. They are absolutely critical if we want meaningful health care reform that results in a comprehensive, universal, affordable, accessible, high-quality, and equitable health care system. If voters can not choose who will represent them, who upholds their values, we will not see progress. The so-called ‘Great American Melting Pot’ will continue to scorch. To be health care reform advocates, we must also support and advocate for true voting rights nationally and at the state level.

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ACA Consumer Advocacy

ACA Consumer Advocacy is a forum for consumers of health care and the ACA to come together to learn, work with lawmakers, and work toward universal health care.