Written by Jan Hoffman and Abby Goodnough
The Trump administration formally declared its opposition to the entire Affordable Care Act on Wednesday, arguing in a federal appeals court filing that the signature Obama-era legislation was unconstitutional and should be struck down.
Such a decision could end health insurance for some 21 million Americans and affect many millions more who benefit from the law’s protections for people with pre-existing medical conditions and required coverage for pregnancy, prescription drugs and mental health.
In filing the brief, the administration abandoned an earlier position — that some portions of the law, including the provision allowing states to expand their Medicaid programs, should stand. The switch, which the administration disclosed in late March, has confounded many people in Washington, even within the Republican Party, who came to realize that health insurance and a commitment to protecting the ACA were among the main issues that propelled Democrats to a majority in the House of Representatives last fall.
The filing was made in a case challenging the law brought by Ken Paxton, the attorney general of Texas, and officials in 17 other Republican-led states. In December, a federal judge from the Northern District of Texas, Reed O’Connor, ruled that the law was unconstitutional.
A group of 21 Democratic-led states, headed by California, immediately appealed, and the case is before the 5th U.S. Circuit Court of Appeals in New Orleans. The House of Representatives has joined the case as well to defend the law.
Oral arguments in the appeals court are expected in July, with a possible decision by the end of the year, as the 2020 presidential campaign gets going in earnest. Whichever side loses is expected to appeal to the Supreme Court.
As the administration and Texas noted in their briefs, O’Connor’s ruling turned on the law’s requirement that most people have health coverage or be subject to a tax penalty.
But in the 2017 tax legislation, Congress reduced that penalty to zero, effectively eliminating it. O’Connor, the plaintiffs at the state level and now the Trump administration reasoned that, like a house of cards, when the tax penalty fell, the so-called individual mandate became unconstitutional and unenforceable. Therefore, the entire law had to fall as well.