The cities of Chicago, Columbus, Cincinnati, and Baltimore have filed suit in a Maryland federal court, arguing that Russian asset Donald Trump has "waged a relentless effort to use executive action alone to undermine and, ultimately, eliminate the law." The suit says his actions are in violation of the Article II of the Constitution, requiring the president to "take care that the laws be faithfully executed."
As exhibits, the cities have dozens of Trump tweets, like this one "As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!" That shows the intent behind his actions, which include "making it easier for individuals and trade groups to purchase coverage outside the law’s insurance markets; threatening to eliminate cost-sharing reduction payments; cutting funding for “navigators,” or those who help individuals enroll in the program; and using federal funds Congress dedicated to implementing the law toward making videos criticizing it." That's just a partial list of Trump's actions against the law. That last one, though—using funds appropriated by Congress to implement the law going toward propaganda to destroy it—that should be grounds on its own.
Among the suits against Trump from cities and states, this one is different, says Abbe Gluck, a Yale University law professor and expert on Article II, who also happens to be pretty darned good on healthcare policy. That's because it's not about Trump's "faithfully" executing the law, but about deliberately and publicly undermining it. "That's what makes this case novel, first of its kind and really important. … No scholar or court has ever said the president can use his discretion to implement a statute to purposely destroy it. … If there's ever going to be a violation of the 'take care' clause, this is it."
The cities bringing the suit have been hurt by the sabotage, though they'll have to prove that in court. Columbus, for example, has seen an upsurge in uninsured patients at city-subsidized health centers; almost 3,000 in 2017. The cities argue that the strain on their budgets is hampering their ability to respond to the opioid epidemic. Ohio is second in the nation in overdose deaths.