A CALL TO ACTION: RESTORING HEALTH CARE AS A HUMAN RIGHT

There comes a moment in the life of a constitutional republic when the guardians of democracy must decide whether they will stand firm in defense of the people—or capitulate to political pressure that is neither principled nor prudent. In the hours leading up to the reopening of the federal government, we witnessed such a moment. Tragically, some of my Democratic colleagues in the Senate relinquished the very leverage entrusted to them by the American people.

The voters handed Democrats that leverage precisely because they understood who caused the shutdown: a faction of MAGA Republicans who, through procedural maneuvering and ideological hostility, had already stripped Affordable Care Act (ACA) cost-sharing subsidies through the budget reconciliation process. Those subsidies were not removed after bipartisan debate, nor after testimony from public health experts, nor after hearings with families directly impacted. They were removed unilaterally, by a bare partisan majority, under a process intentionally designed to evade accountability.

Thus, when the Senate possessed the moral, political, and procedural upper hand, it was incumbent upon them to negotiate from a position of strength—not retreat.

Yet they retreated.

Reopening the government without restoring ACA subsidies was not merely a tactical error; it was a strategic abdication with consequences that will ripple across every working-class household, every rural hospital struggling to keep its doors open, and every insurer attempting to maintain market stability.

Insurance markets do not operate on wishful thinking; they operate on actuarial certainty. The removal of subsidies without immediate restoration introduced volatility that working families will feel in their premiums, deductibles, and coverage disruptions. The Senate’s concession gave the President and his ideological allies exactly what they wanted: the ability to sabotage the health care system piecemeal, then turn around and blame its wounds on the very programs they are dismantling.

As a scholar of law, policy, and contractual federalism, I must say this clearly: The shutdown gave Democrats their first real leverage to reverse unlawful sabotage. And they forfeited it.

Not because the facts demanded it. Not because the public demanded it. But because some allowed fear of temporary discomfort to overshadow the long-term structural wellbeing of our democracy. I honor their compassion—but compassion is not the same thing as strategy.

I speak this truth prophetically and academically: Soft hearts must never be paired with soft heads. Justice requires both moral conviction and strategic discipline.

Had I been in Congress at that defining hour, I would not have voted to reopen government without restoring what had been wrongfully taken from the American people. I would have insisted on an immediate statutory reinstatement of ACA cost-sharing subsidies—not as a bargaining chip, but as a moral imperative grounded in public law, economic evidence, and human dignity. And, as your future Representative, I will ensure no such leverage is ever surrendered again.

II. WHAT I WOULD HAVE DONE AS A CONGRESSMAN — AND WHAT I WILL DO

As your future Congressman for North Carolina’s 9th District, I would have taken a distinctly different approach:

1. Leverage the Shutdown to Restore ACA Subsidies Immediately

The shutdown was a pressure point created not by Democratic obstinance, but by Republican overreach. With public opinion overwhelmingly blaming Republicans, that was the moment to demand statutory restoration of the ACA subsidies. Instead of capitulating, I would have:

• Drafted and filed the ACA Stability Restoration Act of 202X

• Conditioned my vote to reopen government on its adoption

• Insisted on restoring subsidies before any continuing resolution moved

• Required bipartisan hearings into premium destabilization caused by their removal

  
  

This would not have been obstruction—it would have been constitutional stewardship.

2. Expose the Consequences of Subsidy Removal

Using rigorous public data, I would have presented:

• Actuarial projections showing premium spikes

• Rural hospital insolvency analyses (particularly in NC)

• CBO reports that warned Congress months in advance

• Contract-law principles proving that altering federal subsidy structures mid-cycle violates the reasonable-reliance expectations of consumers and insurers

  
  

3. Introduce a Comprehensive Replacement: “THE HEALTH SECURITY & HUMAN DIGNITY ACT”

Upon entering Congress, I will introduce a legislative package that:

• Restores all ACA cost-sharing subsidies permanently

• Expands premium support for low-income and middle-class families

• Protects rural hospitals through direct stabilization grants

• Prohibits administrative sabotage of enrollment and marketplaces

• Codifies health care as a statutory human right, as Congress has already done with public education, emergency care, Social Security, and Medicare

• Closes the Medicaid coverage gap in states that refused expansion

• Creates a federal public option anchored in cost transparency and competitive pricing

  
  

This is not idealism—this is policy realism coupled with human moral obligation.

Lent Carr for United States Congress Audio Address on Health Care as a Human Right, and Salvaging ACA Protection for Middle Class, and the Marginalized Poor.

III. WHITE PAPER (Option B: Scholarly–Legalistic–Legislative Framework Lent Carr Will Introduce Once Elected to Serve NC-9)

A Congressional Framework for the Health Security & Human Dignity Act

By Professor Lent C. Carr, II, Ph.D.

For Legislative & Committee Review

Executive Summary

The unilateral removal of Affordable Care Act cost-sharing subsidies through the budget reconciliation process created legal, economic, and human impacts that Congress has a constitutional duty to remedy. The Senate’s decision to reopen government without securing restoration of these subsidies represents not only a loss of bargaining leverage but a failure to protect the contractual expectations of millions of Americans who relied upon statutory health insurance frameworks.

This White Paper proposes the Health Security & Human Dignity Act, a federal legislative initiative designed to restore subsidies, stabilize insurance markets, protect rural health infrastructure, and codify health care as a statutory human right consistent with Congress’s authority under the Commerce Clause, Spending Clause, and Section 5 of the Fourteenth Amendment.

SECTION I – LEGAL ANALYSIS

I.A – Reconciliation & Unilateral Subsidy Withdrawal

Under §310(g) of the Congressional Budget Act of 1974, reconciliation may not be used to make “extraneous” policy changes unrelated to federal spending or revenue. The removal of ACA subsidies—without hearings, bipartisan support, or procedural regular order—effectively altered statutory entitlements through a procedural loophole Congress never intended.

I.B – Contractual Reliance & Federal Duty

Families purchased insurance products based on promises codified in 42 U.S.C. §18071 et seq. The abrupt removal of subsidies constitutes a violation of reasonable reliance principles articulated in Perry v. United States, 294 U.S. 330 (1935), and Lynch v. United States, 292 U.S. 571 (1934), where the Court held that the government cannot withdraw contractual obligations to the detriment of citizens without consequence.

I.C – Equal Protection & Health Market Sabotage

The subsidy withdrawal disproportionately harmed:

• Low-income households

• Rural communities

• Individuals with preexisting conditions

• States with higher uninsured rates

  
  

This implicates equal protection concerns under U.S. v. Carolene Products, 304 U.S. 144 (1938), which requires heightened judicial scrutiny when legislative actions burden discrete and insular minorities.

SECTION II – ECONOMIC & PUBLIC HEALTH ANALYSIS

II.A – Premium Instability

CBO analyses and state actuarial reports demonstrate that subsidy removal increases premiums by 20–30% and reduces marketplace participation, creating negative feedback loops that threaten market solvency.

II.B – Rural Hospital Closures

North Carolina alone has experienced multiple near-closures of critical access hospitals. Subsidy withdrawals accelerate such closures by:

• Increasing uncompensated care

• Shrinking insured populations

• Undermining Medicaid expansion incentives

  
  

II.C – Public Health Impact

Subsidy loss correlates with increased mortality rates, lower cancer-screening access, decreased prenatal care, and higher bankruptcies due to medical debt.

SECTION III – LEGISLATIVE FRAMEWORK

THE HEALTH SECURITY & HUMAN DIGNITY ACT

Title I – Restoration of ACA Subsidies

• Reinstates cost-sharing reductions retroactively

• Indexes subsidies to inflation + regional cost of living

  
  

Title II – Rural Health Infrastructure Protection

• $25B stabilization fund for rural hospitals

• Incentives for states to expand Medicaid

  
  

Title III – Anti-Sabotage Enforcement

• Prohibits administrative actions that hinder enrollment

• Requires CMS to maintain outreach and navigator funding

  
  

Title IV – Codification of Health Care as a Human Right

• Establishes statutory right to essential health benefits

• Provides enforcement mechanism under 42 U.S.C. §1983

  
  

Title V – Public Option Implementation

• Federal plan offered on all marketplaces

• Sliding-scale caps on premiums tied to income

  
  

IV. CONCLUSION — THE PROPHETIC WARNING & THE PATH FORWARD

Democrats forfeited leverage once. They must not do so again. The American people entrusted them with a mandate grounded in justice, equity, and moral responsibility.

As your future Congressman, I will not merely react to sabotage—I will legislate against it.

Health care is not a commodity. It is not a bargaining chip. It is not a luxury. It is a human right.

And with your support, I will enshrine that right into the federal law of this nation.