Trump Administration Moves To Further Hobble Affordable Care Act

The Trump administration is calling a key part of Obamacare that protects individuals with pre-existing conditions unconstitutional

The federal lawsuit hinges on the ACA's individual mandate, or the requirement to get health coverage or pay a penalty.

But that mandate was crucial to persuading insurers to offer plans under the ACA. "It's a cornerstone of what they do", he says.

Shortly before the government's court filing Thursday, three career lawyers at the Justice Department withdrew from the case and were replaced by two political appointees, according to court filings.

A group of 17 Democratic-led states that have won standing in the case also filed a brief on Thursday night arguing for the ACA's preservation.

The crux of the argument goes back to Chief Justice John G. Roberts Jr.'s 2012 ruling upholding the constitutionality of the individual mandate as a valid use of Congress's taxing power. Without the tax penalty, they argue, "the Court should hold that the ACA is unlawful and enjoin its operation".

The Justice Department concurred, saying the court should consider ordering that as of January 1, two popular parts of the law will be invalid: that people with preexisting conditions must receive coverage, and that they can not be charged more than healthier consumers. "We are a country of laws, and the law must be respected, defended and enforced regardless of the person occupying the Oval Office", the senators wrote.

Margarita Mills (left), an insurance agent from Sunshine Life and Health Advisors, speaks with Daniela Morales as she shops for insurance under the Affordable Care Act at a store set up in the Mall of Americas, on November 1, 2017, in Miami. Estimates vary widely because there is not a standard definition of what counts as a pre-existing condition.

Diabetes, pregnancy and arthritis are all considered a pre-existing condition. Even if the ACA were to disappear under Republican control, at least a promise to maintain pre-existing condition care would keep their options open. Under normal circumstances, the federal government would defend the law.

If that argument prevails in the courts, it would render unconstitutional Obamacare provisions that ban insurance companies from denying coverage to people with pre-existing conditions - arguably the most popular component of the 2010 health care law. Ultimately, the case may be heading for the Supreme Court. "The pre-existing condition protections are extremely popular on both sides of the aisle".

More immediately, there might be some effect on premiums for next year.

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Without the mandate, insurers have warned of premium price hikes for 2019, and states have already reported increases, as payers fear healthy individuals will flee the ACA market, leaving a higher-cost, riskier population. In the case of health care, "fortunately we have 16 other [Democratic attorneys general] who are prepared to do it with us".

But others say the legal brief may have minimal impact next year on premiums.

The Senate's top Democrats fired off a letter to President Trump on Friday to denounce the decision and urged Trump's Justice Department to reverse course. "United States are correct that Section 5000A (a) [the individual mandate] will be unconstitutional when the Jobs Act's amendment becomes effective in 2019".

Also, 39 percent of registered voters in today's NBC/WSJ said they are enthusiastic or comfortable with a candidate seeking to repeal Obamacare, compared to 49 percent who said they have reservations or were very uncomfortable with a candidate seeking to repeal the health care law. Now his administration is walking back on that promise in a major way.

"When Congress reformed the tax system in December 2017, it removed the tax penalty for failing to comply with the mandate", Reyes said.

In 2015, the court ruled that Congress did not intend to provide financial aid exclusively for premiums to individuals in states that operated their own insurance exchanges.

Other legal observers point out that's not how the lawmaking process works. Fifty-two million Americans with preexisting conditions are at risk or denial of coverage or higher premiums, wrote Timothy S. Jost, JD an emeritus professor at the Washington and Lee University School of Law. "That's what Congress did when it zeroed out the mandate. Congress made that choice". California Attorney General Xavier Becerra, joined by 16 other attorneys general, said in April he would "vigorously" defend the ACA. But the lawsuit has been filed in a conservative court in Texas, and the Trump administration's refusal to defend key parts of the law has likely boosted the plaintiffs' chances.

"I favor protecting those in our society with pre-existing conditions, but I don't want to put the cart before the horse", said Mr. Lance, who voted against the GOP replacement bill. In addition, this will create even more uncertainty in a challenging healthcare market. The Justice Department says only the protections for people with preexisting conditions are linked to the tax - not the rest of the law, including the expansion of Medicaid. Under the current health care law individuals can not be denied healthcare due to their existing health condition.

Kaiser Health News, a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente. "That's as flagrant a violation of the President's constitutional duty to take care that the laws are faithfully executed as you can imagine".

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