The Trump administration has endorsed a federal court judgment that the Affordable Care Act is unconstitutional. The administration now seeks to dismantle not only protections for patients with pre-existing conditions, but to end Medicaid expansion in more than three dozen states and to upend the insurance marketplaces for individuals across the country.
On Monday, the Department of Justice submitted a brief notice to a federal appellate court announcing that it now believes Obamacare should be thrown out in its entirety, as called for by a December 2018 ruling in district court. “The Department of Justice has determined that the district court’s judgment should be affirmed,” wrote Assistant Attorney General Joseph Hunt, underscoring that “the United States is not urging that any portion of the district court’s judgment be reversed.”
The current case against the ACA was brought by Texas and 17 other state attorneys general, and late last year federal district Judge Reed O’Connor ruled for the plaintiffs. The twists of the case are complex: The Supreme Court ruled in 2012 that a penalty imposed on people who did not buy insurance under the law’s “individual mandate” provision was a tax, and therefore constitutional. But because the Trump tax-cut law of 2017 eliminated the financial penalty associated with the mandate, Judge O’Connor ruled, the ACA is no longer protected under Congress’ taxing authorities — and has become unconstitutional in full. In his controversial ruling, O’Connor likened passage of the Trump tax bill to pulling a crucial block out of a Jenga tower, causing the entire ACA to collapse.
Previously, the Trump administration had argued that parts of Obamacare should survive in this case. In a June 2018 legal brief, the Justice Department argued that the individual mandate was unconstitutional, and that the court should also do away with the “guaranteed issue and community rating requirements” of the law; these provisions ensure that anyone can purchase an insurance policy regardless of a preexisting condition. At the time, the Trump administration argued that these three provisions of Obamacare were “severable from the ACA’s other provisions,” meaning the rest of the law could stand.
With Monday’s reversal, the Trump administration is advocating to blow up the American health-care system. The tentacles of the Affordable Care Act extend well beyond the individual insurance marketplace, into Medicaid, Medicare, the coverage guarantees of most employer-based health plans — and even into public health measures like calorie counts on restaurant menus.
Democrats of all stripes are sounding the alarm. On Twitter, Hillary Clinton called this “dramatic escalation” of the Trump administration’s legal crusade against Obamacare a “sickening attack on people with pre-existing conditions, seniors, and young people.” Clinton — whose 2008 health-care platform served as the template for the Affordable Care Act — laid out the dire consequences if the lower court ruling is upheld:
If Republicans prevail in court:
– 20 million people will lose coverage
– Protections for pre-existing conditions will be gone
– Young people won't be able to stay on their parents' plans until age 26
– Limits on coverage will return
– Caps on out-of-pocket expenses will be gone
— Hillary Clinton (@HillaryClinton) March 26, 2019
Trump’s attack on the ACA has already become a flashpoint in the 2020 campaign. Surging presidential contender Pete Buttigieg highlighted the lack of a Plan B by the administration and the GOP:
If you benefit from the #ACA, it is now the official position of the White House to take away your health coverage, with no sign of a plan to help you if they win and you lose.
— Pete Buttigieg (@PeteButtigieg) March 26, 2019
Sen. Kirsten Gillibrand (D-NY) — another Democratic presidential candidate — seized on the political opportunity presented by the administration’s broadside at a law that’s become popular with voters:
If it’s a fight for healthcare this administration wants, it’s a fight they’ll get—and we will win. https://t.co/mO2hojmB4X
— Kirsten Gillibrand (@SenGillibrand) March 26, 2019
In response to the chorus of criticism, our extremely online president surfaced to make a vague and sweeping promise:
The Republican Party will become “The Party of Healthcare!”
— Donald J. Trump (@realDonaldTrump) March 26, 2019
Despite the administration’s striking about-face Monday, nothing is changing in relation to the enforcement of Obamacare, for now. The lower-court ruling is on hold, pending appeal. And the ultimate fate of the Affordable Care Act seems destined, once again, to be decided by the Supreme Court.