Trump Administration Reverses Course, Formally Asks Court to Strike Down Entire ACA

On Monday, the Trump Administration reversed its previous position on ongoing litigation related to the Affordable Care Act (ACA), asking a federal appeals court to strike down the act in its entirety.

Recall, in December 2018, U.S. District Judge Reed O’Connor of Texas ruled in favor of a group of Republican attorneys general and governors, determining that the ACA in its entirety was unconstitutional because the individual coverage mandate tax penalty was removed as part of the 2017 tax reform measure passed by Congress. After his initial ruling, Judge O’Connor then issued a stay on his ruling upon request by a group of Democratic attorneys general and governors, led by California Attorney General Xavier Becerra, allowing the ACA to stand while O’Connor’s judgement underwent an appeal.

At the time, the Trump Administration declined to support the Republican plaintiff’s argument, and instead argued that other key components of the ACA, such as Medicaid expansion, could survive because they could be considered legally distinct from the individual mandate and other consumer protections such as prohibitions on charging more or refusing coverage for individuals with preexisting conditions.

However, in a two-sentence letter on Monday to the appeals court handling the case, a federal official indicated, “The Department of Justice has determined that the district court’s judgment should be affirmed.” With this submission to the court, the Trump Administration has formally endorsed the elimination of the ACA in its entirety, no longer maintaining its stance that other key components of the ACA could stand without the individual mandate and certain consumer protections.

California Attorney General Xavier Becerra, leading a coalition of 21 attorneys general, swiftly filed an opening brief on the recent developments of the case, arguing that every provision of the ACA remains valid. Declaring the lawsuit and federal position reversal “as dangerous as it is reckless,” Becerra further argued that plaintiffs do not have standing to challenge the individual mandate provision because the plaintiffs are not injured, there is no evidence that plaintiffs will be required to spend more money, and that the district court wrongly concluded that the individual mandate was unconstitutional.

The opening brief also describes the potential dire impacts on the entire U.S. healthcare system and its residents if the district court’s decision that the ACA is unconstitutional is affirmed, indicating that over 133 million Americans, including 17 million children, with preexisting conditions, over 12 million Americans who gained coverage through Medicaid expansion, and over 12 million older adults who receive a Medicare benefit for prescription drugs would be harmed.

In addition to the legal response filed by Becerra and other attorneys generals, Congressional Democrats introduced legislative package on Tuesday afternoon which would seek to reduce healthcare coverage costs and protect consumers with preexisting conditions. Though, with split chambers of Congress, the measures likely face a difficult road ahead. It remains to be seen how the Trump Administration’s reversal in opinion will impact the ongoing appeal to Judge O’Connor’s ruling on a matter that is increasingly likely to end up in front of the U.S. Supreme Court.