Americans keeping an eye on the future of the Affordable Care Act at the Supreme Court, the probability of a COVID-19 vaccine in 2020, and factors impacting the U.S. elections had better eat their Wheaties Oct. 22 — or whatever breakfast cereal boosts their stamina — because all three issues will be involved in major events that day.

The U.S. Senate Judiciary Committee is set to vote on President Donald Trump's Supreme Court nominee, Judge Amy Coney Barrett, on Oct. 22, putting in play a decision on final confirmation by the full chamber before the Nov. 3 U.S. election.

During the committee's four-day hearing last week to vet Barrett, Democrats argued Trump's nominee would side with the court's conservative justices to invalidate the Affordable Care Act, or ACA, in its entirety, and end the decade-old law's many provisions and protections, which could result in millions of Americans being left without healthcare coverage and those with preexisting conditions vulnerable to insurance discrimination.

If the ACA is struck down, many programs the Trump administration is relying on to lower costs and the prices of medicines, such as the Center for Medicare and Medicaid Innovation and the Biologics Price Competition and Innovation Act, would also be invalidated.

The Supreme Court is set to hear oral arguments Nov. 10 in a lawsuit filed by a cadre of Republican state attorneys general, joined by the Trump administration and two individuals. They are arguing that when the Republican-controlled Congress in December 2017 zeroed out the ACA's mandated tax penalty, it rendered the remainder of the law unconstitutional.

However, a number of Republicans on Capitol Hill, including Sen. Lamar Alexander of Tennessee, who heads the Senate's health committee, have insisted Congress never intended to invalidate the entire ACA in their tax reform measure.

The key question for the Supreme Court is whether the individual mandate can be severed from the remainder of the law.

During the four-day Senate Judiciary hearing, Barrett refused to say if she would recuse herself or how she might rule on the ACA questions before the court. She told the lawmakers the "presumption is always in favor of severability."

Barrett also said she held no hostility toward the ACA. But in a 2017 commentary, she criticized Supreme Court Chief Justice John Roberts for siding with the liberal members of the court in upholding the ACA in 2012, saying that he pushed the law "beyond its plausible meaning to save the statute."

About 60% of U.S. adults do not want the Supreme Court to overturn the ACA, the nonpartisan, nonprofit Kaiser Family Foundation reported in a new poll Oct. 16.

During an Oct. 15 online forum hosted by the University of Michigan, a panel of policy experts doubted the entire ACA would be struck down, even with Barrett on the court. The experts agreed that if Democrats take the White House and the Senate and retain the House in November, they are likely to fix the severability and tax penalty issues — rendering the Supreme Court case moot — and provide more funding to reduce healthcare costs.

Vaccines colloquy

Also on Oct. 22, the U.S. Food and Drug Administration will convene one of the most anticipated advisory committee meetings of the year — if not the decade — where a panel of outside experts will discuss the general terms of development and emergency use authorization, or EUA, or licensure of COVID-19 vaccines. The FDA's Vaccines and Related Biological Products Advisory Committee will not be evaluating any specific company's data.

Pfizer Inc., which has been in the lead of developing its COVID-19 vaccine, said Oct. 16 the earliest it would seek an EUA would be the third week of November — meaning Trump will not get his wish to have a product to Americans before they decide who they want in the White House for the next four years.

States were due to submit their COVID-19 distribution plans Oct. 16 to the federal government.

That same day, HHS revealed it had signed deals with CVS Health Corp. and Walgreens Boots Alliance Inc. to administer the products to elderly Americans living in long-term care facilities, who are expected to be among the priority groups to receive the shots when FDA clears them for U.S. marketing.

Trump-Biden final face-off

All three issues — Barrett's nomination, the ACA lawsuit and COVID-19 vaccines — are expected to be wrangled over at the Oct. 22 final debate between Trump and Democratic presidential nominee Joe Biden.

After nearly four years in office, Trump has yet to unveil an ACA replacement plan and Republicans have failed over the past decade to agree on a legislative package.

At an Oct. 15 town hall on NBC, Trump again could not provide details of the plan he has repeatedly promised to unveil since he was on the 2016 campaign trail.

If elected, Biden said he would expand on the ACA by permitting Americans to opt into public insurance coverage, like Medicare, while keeping the private insurance market in place. At an Oct. 15 town hall on ABC, Biden said he plans to raise taxes on corporations and people making over $400,000 annually and use some of those funds to help make healthcare more affordable for all Americans.