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Data: Kaiser Family Foundation, The Cook Political Report; Notes: Those losing insurance includes 2020 ACA marketplace enrollment and 2019 Medicaid expansion enrollment among newly-eligible enrollees. Close races are those defined as "Toss up" or "Lean R/D"; Table: Andrew Witherspoon/Axios

The sudden uncertainty surrounding the future of the Affordable Care Act could be an enormous political liability for Republicans in key states come November.

Between the lines: Millions of people in crucial presidential and Senate battlegrounds would lose their health care coverage if the Supreme Court strikes down the law, as the Trump administration is urging it to.

The chart above shows the number of people enrolled in the ACA's insurance marketplaces or covered through its Medicaid expansion.

  • These options have become especially important over the last six months, as millions of Americans lost their jobs — and thus their employer insurance — due to the pandemic.
  • And more than a quarter of non-elderly Americans have a pre-existing condition that insurers in the individual market could refuse to cover without the ACA, per the Kaiser Family Foundation.

The big picture: Republicans paid a steep electoral price for trying to repeal parts of the ACA in 2017. Republicans' lawsuit against the health care law, if it succeeds, would boot even more people off of their coverage and undo even more of the ACA's regulations.

What to watch: Several vulnerable Republicans, including Sens. Susan Collins, Martha McSally, and Cory Gardner,, represent purple states that expanded Medicaid and would therefore see steep coverage losses. And the broader fight over the Supreme Court has made it impossible to ignore those stakes.

  • "With the Court setting Nov 10 as the date for hearing California v. Texas, Republicans caught a break not having it front and center right before the election.  Now it is very much front and center," said Rodney Whitlock, a former health aide for Sen. Chuck Grassley.
  • "Debates over protection of pre-existing conditions have generally not gone positively for Republicans in purple states/district," he added.

Go deeper

Amy Harder, author of Generate
Nov 9, 2020 - Energy & Environment
Column / Harder Line

Climate change had mixed showing in 2020 elections

Illustration: Sarah Grillo/Axios

Climate change got more attention this election cycle than ever, but the (political) science is mixed on whether it helped or hurt candidates who ran on it.

Driving the news: Joe Biden campaigned on the topic more than any other presidential nominee, which climate activists say is a victory. But his wins in battleground states may have come in spite of it, not because of it, political observers say.

Bryan Walsh, author of Future
7 mins ago - Technology

The smart city comes of age

Illustration: Aïda Amer/Axios

Better sensors, more intelligent AI, and the coming wave of 5G wireless could finally fulfill the promise of the smart city.

Why it matters: How we organize, run and power our cities will be increasingly important in the years ahead, as urbanization expands and the damaging effects of climate change compound.

Ben Geman, author of Generate
9 hours ago - Energy & Environment

Key clean power provision likely won't survive in Dems' spending bill

A construction worker walks along a dirt road at the Avangrid Renewables La Joya wind farm in Encino, New Mexico, on Aug. 5, 2020. Photo: Cate Dingley/Bloomberg via Getty Images

A pillar of Democrats' plans to speed deployment of zero-carbon electricity is likely to be cut from major spending and tax legislation they are struggling to move on a party-line vote, per multiple reports and a Capitol Hill aide.

Driving the news: The New York Times, citing anonymous congressional aides and lobbyists, reports that West Virginia Sen. Joe Manchin (D) has told the White House he "strongly opposes" the Clean Electricity Performance Program.