Trump DOJ looks to gut key Obamacare provision

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

But some GOP lawmakers and political operatives sounded warnings on Friday about the impact of the Justice Department's decision to side with Texas and other states in a lawsuit alleging that because Congress nullified the Affordable Care Act's individual mandate penalty, the rest of the law is invalid. That would include such popular items as the guarantee that young people can stay on their family's health insurance plans until age 26, subsidies to help poorer people to afford health insurance, the existing state-level health insurance marketplaces ("exchanges"), the expansion of the Medicaid health insurance program for poor people, and a mandate that larger employers provided minimum levels of health insurance coverage for their workers.

A Trump administration decision not to defend key parts of the Affordable Care Act in a lawsuit seeking to dismantle it could cause chaos and deprive Americans of coverage, local politicians, providers and insurers said on Friday.

Americans are very divided over the Affordable Care Act, but one piece that many support is the law's protections for those with pre-existing conditions.

An NBC/Wall Street Journal poll released on Thursday - before the Trump administration decision was unveiled - found health care was the top issue for all voters and that it's an issue where Democrats have an overwhelming advantage.

Democrats "don't have to defend how the ACA works" as they did when President Obama was in the White House, said Robert Blendon, a Harvard expert on healthcare politics.

"The question is, what does this do to insurance markets now?" said Jost.

The president last fall ended "cost-sharing reduction payments" to insurers that offset discounts that the law promises to lower-income customers in the out-of-pocket costs for ACA health plans.

Protections for individuals with pre-existing conditions are connected with the individual mandate, according to the Justice Department, meaning that they must also be struck down.

Eyles said that AHIP plans to file a brief in the case laying out "more detail about the harm that would come to millions of Americans if the request to invalidate the ACA is granted".

Twenty Republican state attorneys general filed suit on February 26, charging that Congress' changes to the law in last year's tax bill rendered the entire ACA unconstitutional.

Loosening the health law's rules on pre-existing conditions and on charging more to older adults is a key goal for the Trump administration.

The Justice Department wants the Texas court to hold that the ACA individual mandate is essential to the ACA "community rating" system, or medical underwriting restrictions.

Sessions, in his letter to Ryan, said that the parts of the law restricting the variance in the premiums that could be charged and requiring insurers to cover everyone did hinge on the mandate, because without the mandate, "individuals could wait until they become sick to purchase insurance, thus driving up premiums for everyone else". The administration's legal brief, filed Thursday in federal district court in Fort Worth, Texas, takes aim at those links.

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

Last year, the House passed an Obamacare replacement but the Senate failed to pass its own, after three Republicans voted with Democrats to kill a bill that leveraged special budget rules to avoid a filibuster.

"I find it impossible to believe that the many talented lawyers at the department could not come up with any arguments to defend the ACA's insurance market reforms, which have made such a difference to millions of Americans", he told The Associated Press. "For the people not affected by the ACA, or not particularly supportive, I don't know that it will matter much".

Andy Kim, a former Obama administration staffer, is making coverage of pre-existing conditions and access to affordable health care a key part of his campaign against Rep. Tom MacArthur in Central New Jersey, the author of the Obamacare repeal bill that passed the House but failed in the Senate past year. If the court ends up siding with the Trump administration and the Republican states that brought the suit, the consequences would be significant, Perlman said. It will lead to "renewed uncertainty in the individual market" and a "patchwork of requirements in the states" and make it more challenging to offer coverage next year.

"Texans have known all along that Obamacare is unlawful and a divided Supreme Court's approval rested exclusively on the flimsy support of Congress's authority to tax", said Paxton when the suit was filed.

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

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