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The nominee’s approach to politically charged healthcare topics, such as the ACA and abortion, are among the items at issue in the debate.

Confirmation hearings for U.S. Supreme Court nominee Judge Brett Kavanaugh began with fireworks Tuesday morning before the Senate Judiciary Committee.

Democrats and protestors alike interrupted Chairman Chuck Grassley, R-Iowa, repeatedly in apparent attempts to block the hearing from proceeding. The episode reflects a high-stakes and largely partisan debate that could dramatically impact U.S. healthcare for decades to come.

Kavanaugh, 53, would be the second-youngest member on the court if confirmed, resulting in a 5–4 reliably conservative majority, as NPR reported. His approach to hot-button healthcare topics, such as abortion and the Affordable Care Act, have received particular scrutiny.

On the presidential campaign trail, then-candidate Donald Trump promised to nominate only justices who would overturn Roe v. Wade. Kavanaugh reportedly told one senator that he views Roe as “settled law.” But that doesn’t necessarily mean he believes Roe can’t be overturned, as The Atlantic’s Garrett Epps wrote.

Kanaugh dissented in an opinion last year, writing that the government has “permissible interests in favoring fetal life, protecting the best interests of a minor, and refraining from facilitating an abortion,” and it “may further those interests so long as it does not impose an undue burden on a woman seeking an abortion.”

Another healthcare-related decision by Kavanaugh likely to come up is his 2011 dissent holding that the ACA’s individual mandate was legal as a tax authorized by the Commerce Clause.

Kavanaugh’s reading could come full circle, if a legal challenge launched by conservative states progresses to the Supreme Court. The states argue that the entire ACA was rendered unconstitutional when Congress zeroed out the tax penalty tied to the individual mandate, canceling its status as a tax. In response to the lawsuit, the Trump administration abandoned its defense of key ACA provisions.

It’s worth noting, though, as Bloomberg’s Sahil Kapur did, that Kavanaugh’s 2011 ACA ruling effectively “ducked the issue,” enabling him to avoid ruling on the ACA’s merits. That’s significant because some senators have said Kavanaugh’s views on the ACA will affect how they vote on his nomination.

While liberals fear that Kavanaugh could contribute to the ACA’s dismantling, some conservatives worry he’s too moderate on the ACA. Kavanaugh himself has reportedly signaled in private meetings with Democrats that that he’s skeptical of certain claims in the current Republican-led effort to overturn the Obama-era law.

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