As we await the word–or more likely, many words–from the Supreme Court about the constitutionality of the Affordable Care Act, I strongly recommend Ezra Klein’s latest Bloomberg column, which offers a poignant reminder of how quickly, massively, and recently we lost a bipartisan consensus that every American ought to have health insurance:

Democrats and Republicans used to argue over how best to achieve universal coverage, but both agreed on the goal. The first president to propose a serious universal health-care plan was Harry Truman, a Democrat. The second was Richard Nixon, a Republican. In the 1990s, when President Bill Clinton was arguing for a national health-care system based on an employer mandate, Republicans were arguing for one based on an individual mandate.

In the 2000s, Romney used the individual mandate to make Massachusetts the first state to actually achieve near-universal coverage. On the national level, Republicans as diverse as Newt Gingrich, Lamar Alexander and Lott joined him. Republicans sometimes like to present their support for the individual mandate as a youthful indiscretion, but as late as June 2009, Charles Grassley, the ranking Republican on the Senate Finance Committee, was telling Fox News that “there is a bipartisan consensus to have an individual mandate.”

Today, Romney touts a health-care plan, to the extent he has one, that would almost certainly lead to reduced insurance coverage. He wants to repeal the Affordable Care Act, cutting loose 31 million Americans who are expected to gain coverage under the law. Then he wants to drastically cut Medicaid spending by turning it over to the states and capping the growth of federal contributions. The Urban Institute estimates that such a policy would cause 14 million to 19 million Americans to lose Medicaid coverage.

This, perhaps, is one of the clearest differences between the Republicans and Democrats in this election: health insurance for 45 million to 50 million people.

Today’s decision could have, should have been of primarily academic interest, requiring at most a redesign of the Affordable Care Act, instead of representing a life-or-death turning point for millions of Americans. Thanks to the unilateral Republican abandonment of the goal of universal health coverage, we face the sobering possibility that today will be remembered as the high-water mark for the uninsured, never to be achieved again. It really didn’t have to be that way.

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Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.