To say that the future of the U.S. health care system is in the hands of voters in Georgia tomorrow is not hyperbole. We will soon know whether President-Elect Biden will have any chance of enacting changes he campaigned on to make health care both more affordable and more accessible.

With all the other races having been decided, the current makeup of the Senate is 50 Republicans and 48 Democrats. If either David Perdue or Kelly Loeffler is reelected, Mitch McConnell of Kentucky will remain in control of the Senate, and we can be certain that he will block any reform proposals Biden and Congressional Democrats might try to advance. If Perdue’s and Loeffler’s challengers—Jon Ossoff and Raphael Warnock, respectively—prevail, control of the Senate would shift to the Democrats because Vice President Kamala Harris would be able to cast the deciding vote for the Senate Majority Leader and also to break any tie votes on legislation.

Incumbent Sen. Kelly Loeffler, Senate candidate Reverend Raphael Warnock, Incumbent Sen. David Perdue and Senate candidate Jon Ossoff

Among other health care reforms, Biden has proposed lowering the age of Medicare eligibility to 60 and establishing a public health insurance option to compete with private insurers.  He also campaigned on improving the Affordable Care Act to make federal subsidies available to more people. Currently, the cutoff for subsidies in the form of premium tax credits to help defray the cost of health insurance purchased through the state exchanges is 400 percent of the federal poverty level. 

McConnell has vowed numerous times since the ACA was passed in 2010 to repeal the law “root and branch.” While he and his fellow Republicans have not been able to do that, they have stood in the way of any efforts to improve and expand the law to benefit more people. 


Perdue, who was first elected in 2014, has voted repeatedly to overturn the law. If the repeal efforts had succeeded, all of the benefits of the ACA, including protections for people with pre-existing conditions, would have gone away. It’s worth noting that before the ACA was enacted, insurers had refused to sell coverage to millions of people because of a previous illness or condition. That’s one of the big reasons why the number of people without insurance in the United States had reached 50 million by the time President Obama signed the ACA into law. As a result of the ACA, insurers not only cannot refuse to sell coverage to anyone because of a pre-existing condition, but they also cannot charge people more because of their health status. 

Loeffler has only been in the Senate for a year—she was appointed by Georgia Gov. Brian Kemp in December 2019 to replace Sen. Johnny Isakson, who resigned—but she has also been hostile to the Affordable Care Act. She has become popular with insurance companies, though, because she has campaigned on allowing insurers to sell policies that cost less, but offer fewer benefits than is permitted by the ACA, which, thankfully, outlawed the sale of “junk insurance.” Loeffler, the richest person in the Senate, wants to once again put more Americans at risk of being inadequately insured. 

“Loeffler, the richest person in the Senate, wants to once again put more Americans at risk of being inadequately insured.”

Perdue is also a favorite of the health insurance industry. He is one of the few members of the Senate to have received campaign donations from the political action committees (PACs) of every one of the six biggest for-profit health insurers (Anthem, Cigna, Centene, CVS/Aetna, Humana and UnitedHealth Group). In fact, one of Perdue’s top five contributors since 2015 is Centene, which manages several states’ Medicaid programs and sells Medicare Advantage plans in numerous markets across the country.

If Ossoff and Warnock win tomorrow, McConnell will have to turn the gavel over to Democrat Chuck Schumer of New York, the current Minority Leader. Georgians played a key role in the presidential race in November. As important as their votes were then, they are even more important now.