In case the situation with the latest Obamacare lawsuit, King v. Burwell, wasn’t surreal enough, along comes the anti-Obamacare lawyer Michael Carvin, and some of his, um, more colorful ideas about why the Affordable Care Act is bad law. Trying to contrast the ACA with the constitution, Carvin characterized the ACA as “a statute that was written three years ago, not by dead white men but by living white women and minorities.”

It’s startling to see an Obamacare opponent so bluntly characterize efforts to destroy the law as a way to preserve white male privilege in this way, much less taking it so far as to suggest the privileges of dead white men count for more than the needs of living women and people of color. But it shouldn’t be. The race- and-gender-based opposition to the ACA has been baked into the fight against it from the beginning, when the bill was very nearly derailed by opponents claiming that it would somehow override federal bans on funding abortion.

Since then, though rarely with as much directness as Carvin, the conservative fight against Obamacare has been about needling the gender- and race-based resentments of the conservative base in an effort to demonize Democratic efforts to create universal health care.

Ugly racial attitudes influenced the opposition to Obamacare in two major ways: Hostility to the black President that signed it into law and hostility to the black people who might get better healthcare through it. It’s exceedingly rare to find, outside of Carvin’s bizarre comment, any conservatives overtly mentioning race in their objections to Obamacare. But then again, they don’t need to. All they need to do is whip out the standard conservative talking points that have racially loaded implications built right into them: “States’ rights,” “welfare queens,” loaded warnings about the supposed wave of laziness about to crest over our nation. All these ideas are rooted in our nation’s history of racism—indeed, “states’ rights” was invented to justify slavery and then segregation—and the way that conservatives lean on these ideas now suggest that one of the unspoken but heavily insinuated arguments against Obamacare is that it’s a way for the federal government to steal health care from white people and give it to black people. Adds a new dimension to the fear of “death panels” when you think about it.

Social science, as Paul Waldman showed in the Washington Post last May, bears this out: Attitudes about race and about the ACA are tightly interwoven. Research has shown that negative attitudes about black people increase hostility to health care reform, that opinions about health care reform polarized by racial attitudes after Obama’s election, and that nativist attitudes predicted hostility to health care reform. Research has found that white people with high racial resentment, regardless of their opinion on Obama, view health care reform as a giveaway to lazy black people. You can see why people don’t say these things out loud in public, but the eyebrow-wriggling and hinting has been strong throughout this debate.

The gender-baiting, in contrast, has been way more explicit. Ever since the HHS announced that contraception would be covered as co-pay-free preventive service, conservative media has gleefully portrayed the ACA as a program to give hot young sluts an opportunity to screw on the public dime, an argument that managed to get this narrow provision all the way to the Supreme Court. Never mind that young women with private insurance are no more on the public dime than any other people who have private health insurance. The idea that sexy young things are having fun without you but making you pay for it has been just too provocative for conservative pundits to let facts get in the way.

Arguably, race and gender anxieties are the reasons that healthcare reform, which would otherwise be a dry economic issue, has been such an ugly fight in this country. Healthcare is about bodies, after all. Racism and sexism are about a lot of things, but bodies are a big part of it, and whether or not people should have unequal status based on what bodies they have. Granting white and male bodies better care, on average, that female bodies and bodies of people of color get is a major way to preserve these kind of racial and gender hierarchies. Of course legislation that might equal out the kinds of care we receive is going to be a threat. But you don’t usually see people like Carvin spell it out so plainly.

Amanda Marcotte is a freelance journalist who writes frequently about liberal politics, the religious right and reproductive health care. She’s a prolific Twitter villain who can be followed @amandamarcotte.