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In 2018 and in the midst of a U.S. Senate campaign, Patrick Morrisey, West Virginia’s two-term attorney general, signed onto a lawsuit arguing that the Affordable Care Act — also called Obamacare — was unconstitutional. 

Morrisey lost that race to Democratic incumbent Sen. Joe Manchin. But two years later, Morrisey’s back on the ballot, seeking election to a third term as attorney general, and the effort to overturn the ACA remains at the center of his campaign.

Patrick Morrisey

The case, which is scheduled to be heard by the U.S. Supreme Court on Nov. 10, is part of a longtime effort by leading Republicans to undo one of the most pivotal successes of the Obama administration.

When the ACA was enacted in 2010, the goal of the law was to make healthcare more accessible and more affordable for more people. The ACA subsidized health insurance plans for working-class Americans and expanded the Medicaid program in certain states, to insure the working poor. 

The law also made it illegal for private insurance companies to refuse coverage to customers or charge more based on their medical histories.  

But some people faced rising premiums after the ACA was enacted, and in its original form, the ACA put in place an individual mandate that required most Americans to enroll in insurance programs or face a penalty. In 2019, that mandate was deemed unconstitutional. 

Now, the question the Supreme Court will answer is whether the reversal of the individual mandate makes the whole ACA unconstitutional and susceptible to being overturned. Morrisey is one of 18 Republican attorneys general to argue ‘yes’. 

With the recent death of Supreme Court Justice Ruth Bader Ginsburg, who supported the ACA, and President Trump’s nomination of judge Amy Coney Barrett to replace her, state lawmakers and health care professionals worry that the ACA, with its protections for people with pre-existing conditions, and the billions of federal dollars that enter states through its programs, could be taken away.

Sam Petsonk, a Beckley-based lawyer and Morrisey’s Democratic opponent, opposes attempts to reverse the law.

Petsonk, who is the son of a black lung doctor and was a staffer for the late U.S. Sen. Robert C. Byrd, has made protecting the ACA central to his campaign, and has challenged Morrisey strongly on the issue.

Petsonk said that more than 180,000 people in West Virginia are insured through the ACA, and to take that coverage away would be devastating for public health.

Sam Petsonk

“Patrick Morrisey took it upon himself to sign onto a lawsuit in the name of West Virginians that would take away health insurance for roughly one in 10 people in the state,” said Petsonk. He added that the ACA not only provided insurance to uninsured West Virginians, but expanded black lung benefits for miners and funded state health initiatives, too. 

Morrisey did not respond to requests for an interview. His campaign manager, Bryan Hood, emailed a statement that disputed Petsonk’s assertion.

“Our opponent predicts doom and gloom, yet none of these have come true or will come true,” Hood wrote. “The Attorney General wants to … rein in Obamacare’s out of control premiums; arguments that he wants to eliminate health care or harm those with preexisting conditions are just false.”

When the Affordable Care Act was signed, millions of uninsured Americans gained access to health insurance for the first time. The act put in place protections for Americans living with pre-existing conditions, which made it illegal for insurance companies to deny people coverage.

More than 720,000 West Virginians younger than 65 were living with pre-existing conditions in 2018, according to a report from West Virginia University. The reversal of the ACA would result in a loss of insurance protections for them.

In September, a group of West Virginia physicians and health care providers  sent a letter to Morrisey asking him to retract the state’s involvement in the lawsuit to eliminate the ACA, and asking if the elimination would mean West Virginians with pre-existing conditions would lose coverage or experience price-gouging from insurance companies.

Throughout his attempts to undo the ACA, Morissey has closely aligned himself with the president, who has similarly advocated for striking the law. Following the death of Justice Ginsburg, Morrisey praised Trump’s Supreme Court nominee, Barrett, who has previously criticized the ACA, but it’s unclear whether she’d support striking the law completely.

Morrisey has insisted that the reversal of the ACA would not affect residents with pre-existing conditions, a promise the president echoed just last week. The attorney general has repeatedly assured West Virginians that protections for residents with pre-existing conditions will be put in place in the state regardless of the fate of the law. 

The trouble is that neither Morrisey nor Trump has complete control over that. 

During the last legislative session, state lawmakers did not pass a bill pushed by Morrisey that would stop insurance providers from denying coverage to people with pre-existing conditions. The bill was opposed by ACA advocates and left-leaning policy groups, who said Morrisey’s bill fell far short of the protections now offered under the ACA.

And proponents for the ACA, like Petsonk, say that prohibiting insurers from denying coverage isn’t enough. Petsonk said there need to be guarantees that other advantages of the bill, like the billions of dollars in federal funding that West Virginia receives from it, won’t be lost.

“When Morrisey attacks the federal health care dollars, he is attacking the most significant source of addiction treatment and recovery funding in the state,” Petsonk said. “Our economy cannot afford and our people cannot afford to lose the billions of dollars of funding for health care that our state receives because of the ACA.”

Morrisey has not responded to questions about a plan to replace federal dollars lost if the ACA were to be fully eliminated. 
The two candidates have yet to partake in a moderated debate as of Oct. 5, but MetroNews recently reported that Morrisey agreed to a debate moderated by the radio network. Petsonk, who has called on Morrisey to participate in three debates before the election, expressed displeasure at the attorney general waiting until a month before election day to agree to debate their differences before voters.

Lauren Peace is a Report for America Corps Member who covers public health.