U.S. Justice's ACA decision is latest of many shifts

U.S. Justice's ACA decision is latest of many shifts

While the case still must play out before the nation's high court, the Justice Department's decision to not defend the law could create some uncertainty for health insurers that sell plans on the Affordable Care Act marketplace, according to Larry Levitt, a Kaiser Family Foundation senior vice president who closely monitors the health law.

Democrats swiftly portrayed the surprise move by the Justice Department, outlined Thursday in a brief supporting a court case filed by Texas and 19 other states, as a harsh blow to Americans with fragile health and their families.

Department of Financial Services Superintendent Maria Vullo, the state's top health insurance regulator, wrote in a Crain's op-ed last month that she would not let the uncertainty stemming from the Trump administration's actions on the ACA lead to an increase in premiums.

Casey accused the administration and congressional Republicans of wanting "to use the courts to enact the rest of their health care scheme - starting by allowing people to be denied coverage due to a pre-existing conditions and charging older Americans more for their health care".

Senate Democratic Leader Chuck Schumer of NY urged President Donald Trump to reverse the decision.

The Trump administration delivered an early midterms present to Democrats Thursday night when the Justice Department made a decision to side with 20 GOP states in a lawsuit seeking to gut the core protections of the Affordable Care Act for people with pre-existing conditions. But insurers said the legal debate alone could cause turmoil in insurance markets this summer. They say the rest of the law is not able to be separated from the mandate, and therefore should also be overturned.

Sen. Susan Collins, R-Maine, who voted against the Republican repeal bills in the Senate a year ago, also expressed concern about the administration's new push, saying it "creates further uncertainty that could ultimately result in higher costs for millions of Americans and undermine essential protections for people with pre-existing conditions, such as asthma, cancer, heart disease, arthritis and diabetes".

America's Health Insurance Plans said Friday that it plans to file a brief opposing the plaintiffs' request for emergency relief that would provides detail about the harm that would come to millions of Americans should their request to invalidate the ACA is granted either in whole or in part.

The states are now arguing that once Congress repealed the tax penalty for the individual mandate in the 2017 law, no more constitutional authority exists for Congress to keep the individual mandate in place.

Many health care experts disagree with that position.

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But Marty Lederman, who worked in the Obama Justice Department and now teaches at Georgetown Law School, says the move was unprecedented. What's at issue here is the fact that Congress is getting rid of the penalty for the individual mandate, reducing it to zero as of next January 1 - January 1, 2019.

"In refusing to follow bipartisan tradition and defend the ACA in the US federal court system, the Trump administration is nakedly admitting that it wants to eliminate protections for people with pre-existing conditions, breaking a promise that the president has made time and again", said Topher Spiro, vice president of health policy at the Center for American Progress.

Nevertheless, the Justice Department's position did not go quite as far as the Texas suit.

A coalition of 20 states led by attorneys from Texas and Wisconsin sued the government in February for the repeal of the Obamacare provisions.

Some Democratic politicians didn't waste much time. The second, called community rating, prevents carriers from charging more to those who are sick or had conditions in the past. "For the Trump administration to crumple that up and throw it out the window is galling". But it's crucial to remember that this was exactly the reaction of the same set of people in 2010, when the original argument was made against the individual mandate by libertarian law professor Randy Barnett.

Sessions said in his letter that the Justice Department was not arguing that the entire law did not pass constitutional muster. President Trump has said he wants a repeal and replacement of the law.

Attorney General Jeff Sessions said in a letter to Congress that Trump, who campaigned on repealing the law and almost did so his first year in office, approved the legal strategy.

Today, surveys suggest most Americans see the legislation in a generally positive light, a reversal from most of its eight-year history.

But polls show support for the law increasing as it becomes more imperiled, and the result has been a political sea change. But it does certainly raise the prospect of a court decision that would say there could be no more protections for people with preexisting conditions.

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