The Trump Justice Department has shifted its position on the Affordable Care Act, now asking a federal court to strike down the law entirely. Last year, Justice argued in briefs filed in a federal court in Texas that certain provisions of the law, including those protecting people with pre-existing conditions, should be invalidated. In December, the "intensely political" Judge Reed O'Connor went further, invalidating the entire law.
Now in appeal at the 5th Circuit, Trump’s Justice Department has decided to go with O'Connor's ruling. Previously, it had argued only that the law's consumer protections should be struck down, despite Trump's midterm-election declarations that "Republicans will totally protect people with Pre-Existing Conditions, Democrats will not! Vote Republican" and "I will always fight for, and always protect, patients with preexisting conditions. You have to do it. You have to do it." There is no Republican plan to replace Obamacare. There never has been. It is myth.
So what would be lost? Coverage for about 20 million people. Yes, that includes protections for people with pre-existing conditions, along with the subsidies that make buying insurance affordable for many families getting individual plans. Coverage for the millions of low-income people who are in Medicaid expansion states. People covered by their parents' plans until age 26. Basic primary care such as physicals and vaccinations available with no extra charge. Protections against caps on how much insurance will pay during a year, or during the duration of a policy. Important changes to Medicaid and Medicare would be gone, including the billions in savings on prescription drugs Medicare recipients have gained since the law passed. What would be lost is all that the law did, but because it's a "super statute," touching so many aspects of health care, it would have a massive, detrimental impact on the whole system.
"To erase a law that is so interwoven into the health care system blows up every part of it," said Sara Rosenbaum, a health law professor at the George Washington University School of Public Health. "And [the ACA] is a super statute. It has changed everything about how we get health care." There is no part of the whole system—nearly one-fifth of the nation's whole economy—that hasn't changed under the law. The economic effects should it be erased could be dire.
Even foes of Obamacare such as libertarian free-marketer Peter Suderman are calling foul. "By all appearances," he writes, "the Trump administration is taking a political position for political purposes, ignoring the strongest legal arguments in the process." That political purpose is to entirely erase the most significant achievement of President Barack Obama. Period. Because it's going to be political disaster for Republicans in 2020.
Trump might be feeling his oats after the fiasco Attorney General William Barr created with the Mueller report. This is him and Barr unleashed. And it will be his political undoing.