MARY LOUISE KELLY, HOST:
On November 10, a week after Election Day, a changed Supreme Court will hear a case that could reshape U.S. health care. The lawsuit, brought by 18 states and backed by President Trump, seeks to strike down the Affordable Care Act. Coverage for roughly 20 million people is on the line. And Republicans up for election are treading carefully during the pandemic. Ben Paviour from member station VPM takes us to Virginia.
BEN PAVIOUR, BYLINE: Republican Nick Freitas' new office in suburban Richmond isn't designed for crowds, but here people are, masks on and off, angling for yard signs and doughnuts. A campaign staffer scoots everyone outside where Freitas appears.
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NICK FREITAS: Hey, thank you, guys.
PAVIOUR: The former Green Beret launches into an attack on Democrats and his opponent, freshman Congresswoman Abigail Spanberger.
FREITAS: Every single solution she has to a problem includes more government power at the expense of your liberty. And we're not putting up with it anymore in this country.
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PAVIOUR: It's the kind of libertarian message supporters expect from Freitas. As a state delegate, he voted against Medicaid expansion in Virginia, which has insured over 450,000 people. He's attacked the Affordable Care Act, calling it a cancer. But in a recent TV ad, his campaign took a different tone.
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FREITAS: When it comes to preexisting conditions, one thing the military always taught me is nobody gets left behind, and they don't deserve to be left behind either.
PAVIOUR: Other Republicans in swing districts are running similar ads. But Democrats like Spanberger say they're being disingenuous.
ABIGAIL SPANBERGER: I find it unbelievable.
PAVIOUR: Spanberger flipped a Republican seat in 2018 with a large focus on health care. She says Freitas' statement doesn't jive with his record.
SPANBERGER: When he's had the option to vote to protect people with preexisting conditions, specifically children with autism or children with hearing impairment, he has voted against protecting them.
PAVIOUR: There was some coverage for preexisting conditions before the Affordable Care Act, or Obamacare, passed in 2010 but only if you got health insurance through your work. Karen Pollitz with the Kaiser Family Foundation compares it to a game of musical chairs.
KAREN POLLITZ: When the music stops, if you're between jobs, the individual market wouldn't catch you.
PAVIOUR: The ACA required that insurers cover those patients. It also created larger pools of insured people so that those with expensive conditions were balanced out by those who were healthier.
POLLITZ: I'm a cancer survivor. Most of the years, I don't cost my insurance plan anything. But in the years that I've had cancer, I was a six-figure claims girl.
PAVIOUR: If the health law is struck down, Pollitz says the cost of plans would skyrocket. Medicaid expansion could be threatened. Insurance companies warn that repealing the ACA would wreak havoc on the U.S. health care system. And with the passing of Supreme Court Justice Ruth Bader Ginsburg, Pollitz says it's a real possibility.
POLLITZ: Overall, I think it has ratcheted up the level of concern.
PAVIOUR: Nick Freitas says he would vote to get rid of the law with qualifications.
FREITAS: Yes, I want to see Obamacare gone. I also want to make sure that in the interim, as we're moving from one approach to a different one, I want to make sure that vulnerable populations are covered.
PAVIOUR: Freitas points to a Republican bill in the House that would protect preexisting conditions if the ACA is repealed. It's an approach almost all health care experts say will be unaffordable without Obamacare subsidies. Elsie Cimorelli (ph), a 78-year-old Freitas supporter, says she likes the GOP approach. She's unhappy with insurance her son got through the ACA to treat a disability. She trusts Republicans to come up with something better.
ELSIE CIMORELLI: Trump is working on something, so I want to see what that is. I'm sure it's going to be good.
PAVIOUR: President Trump says he has a plan already - a claim he's made repeatedly since 2016. For NPR News, I'm Ben Paviour in Richmond. Transcript provided by NPR, Copyright NPR.