The general election on November 3 could have significant ramifications for many health care programs. State, local, and federal candidates offer various perspectives on what the U.S. system should look like and how programs should be supported or dismantled. Because of its vast importance, health care is always on the ballot.

In a time of COVID-19, health care access is especially critical and, sadly, may be especially at risk. There is dire need for additional COVID-19 relief legislation that supports people with Medicare and Medicaid, including enrollment flexibilities to help people more quickly connect with their coverage.

Just after the election, the Supreme Court will hear oral arguments in a case that could upend the entire U.S. health system, with massive implications for people with Medicare, Medicaid, and private insurance. In addition to expanding Medicaid and closing the Medicare Part D donut hole, the Affordable Care Act created protections for people with pre-existing conditions, allowed parents to keep their children on their insurance to age 26, and improved access to complete coverage benefits.

The election does not have a direct impact on that Supreme Court case, but legislative and administrative choices at both the federal and state levels are extremely important, and they can be subtle. Even choices that seem unrelated, such as reforms to U.S. Postal Service operations, can have health care implications. Here are a few ways that important programs may be affected by election decisions and questions to ask candidates to discern where they stand on the issues.

• Medicare: Ask candidates how they will support and improve the Medicare program. This includes the policies they intend to pursue to lower drug prices, ensuring people with Medicare have access to care; how they will extend benefits to support the well-being and economic stability of beneficiaries; and how they will improve enrollment processes.
  
  Some threats to Medicare may be subtle. If a candidate supports privatization of the program, raising the eligibility age, “premium support,” or “private contracting,” ask questions about what that would mean for out-of-pocket costs, access to doctors, and the integrity of the program. Read: “What’s at Stake in Medicare: A Voter Guide.”

• Medicaid: Ask candidates how they will defend and enhance Medicaid. This includes reducing barriers to enrollment and eligibility, expanding Medicaid in states that have not done so, and supporting people who need care in their homes.
  
  Some threats to Medicaid that candidates may support include imposing harmful bureaucratic hurdles that keep people from accessing the benefits they are eligible for, bypassing federal laws to allow states to reduce benefits, and reducing funding for states. If your candidates endorse such policies, ask how doing so advances the goal of the Medicaid program—to help people access needed care. Read: “What’s at Stake in Medicaid: A Voter Guide.”

• The Affordable Care Act (ACA): Ask candidates how they will improve and expand upon the ACA. Possible improvements include extending subsidies to those who cannot afford coverage, reducing out-of-pocket expenses, and increasing outreach.
  
  In addition to legal challenges, some threats to the ACA you may want to raise during this election cycle include the proliferation of short-term limited duration plans and association plans. These products do not cover pre-existing conditions, the essential health benefits, or otherwise protect those who need coverage. There have also been state schemes that limit people’s access to impartial information about their health coverage options. Ask candidates how they will protect people with pre-existing conditions and keep people from losing coverage. Read: “What’s at Stake in the Affordable Care Act: A Voter Guide.”

In every election, every candidate should be pressed on their stances on these and other health care issues to ensure voters have the opportunity to make an informed choice.

Read more about the lawsuit that threatens the ACA.

Ask your Senators to Act Now on COVID-19 relief legislation.