Trump Admin backs full repeal of Obamacare

by NCN Health And Science Team Last updated on March 31st, 2019,

Washington: The Trump administration broadened its attack on the Affordable Care Act (Obamacare) on Monday, telling a federal appeals court that it now believed the entire law should be invalidated.

The administration had previously said that the law’s protections for people with pre-existing conditions should be struck down, but that the rest of the law, including the expansion of Medicaid, should survive.

If the appeals court accepts the Trump administration’s new arguments, millions of people could lose health insurance, including those who gained coverage through the expansion of Medicaid and those who have private coverage subsidized by the federal government.

“The Justice Department is no longer asking for partial invalidation of the Affordable Care Act, but says the whole law should be struck down,” Abbe R. Gluck, a law professor at Yale who has closely followed the litigation, said on Monday. “Not just some of the insurance provisions, but all of it, including the Medicaid expansion and hundreds of other reforms. That’s a total bombshell, which could have dire consequences for millions of people.”

The new position is also certain to reignite a political furor over the Affordable Care Act, ensuring that it will figure even more prominently in the 2020 elections. Democrats have been saying that President Trump still wants to abolish the law, and they can now point to the Justice Department’s filing as evidence to support that contention.

The Justice Department disclosed its new stance in a two-sentence letter to the United States Court of Appeals for the Fifth Circuit, in New Orleans, and will elaborate on its position in a brief to be filed later.

In the letter, the Justice Department said the court should affirm a judgment issued in December by Judge Reed O’Connor of the Federal District Court in Fort Worth.

Judge O’Connor, in a sweeping opinion, said that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power” because Congress had eliminated the tax penalty for people who go without health insurance.

Accordingly, Judge O’Connor said, “the individual mandate is unconstitutional” and the remaining provisions of the Affordable Care Act are also invalid.

In its letter to the appeals court, the Justice Department said on Monday that it “is not urging that any portion of the district court’s judgment be reversed.” In other words, it agrees with Judge O’Connor’s ruling.

In the nine years since it was signed by President Barack Obama, the Affordable Care Act has become embedded in the nation’s health care system. It changed the way Medicare pays doctors, hospitals and other health care providers. It has unleashed a tidal wave of innovation in the delivery of health care. The health insurance industry has invented a new business model selling coverage to anyone who applies, regardless of any pre-existing conditions.

The law also includes dozens of provisions that are less well known and not related to the individual mandate. It requires nutrition labeling and calorie counts on menu items at chain restaurants. It requires certain employers to provide “reasonable break time” and a private space for nursing mothers to pump breast milk. It improved prescription drug coverage for Medicare beneficiaries, and it created a new pathway for the approval of less expensive versions of biologic medicines made from living cells.

Lawyers said invalidation of the entire law would raise numerous legal and practical questions. It is, they said, difficult to imagine what the health care world would look like without the Affordable Care Act.

The Trump administration’s new position was harshly criticized by the insurance industry and by consumer advocates.

The government’s position “puts coverage at risk for more than 100 million Americans,” said Matt Eyles, the president and chief executive of America’s Health Insurance Plans.

Leslie Dach, the chairman of Protect Our Care, a consumer advocacy group, said: “In November, voters overwhelmingly rejected President Trump’s health care repeal and sabotage agenda. But he remains dead set on accomplishing through the courts what he and his allies in Congress could not do legislatively: fully repeal the law, devastate American health care and leave millions of Americans at risk.”

The Trump administration’s new stance appears to put Republicans in Congress in an awkward position. They have repeatedly tried to repeal the health law. But in the last year, they said over and over that they wanted to protect coverage for people with pre-existing conditions, and those protections are among the law’s most popular provisions.

The lawsuit challenging the Affordable Care Act, Texas v. United States, was filed last year by a group of Republican governors and state attorneys general. Officials from California and more than a dozen other states have intervened to defend the law.

The Texas lawsuit “is as dangerous as it is reckless,” Xavier Becerra, the attorney general of California, said on Monday as he filed a brief urging the appeals court to uphold the law.

Campaign Issue

The Justice Department’s action could prove to be a gift for Democrats as they refocus their campaign message on pocketbook issues. The debate over Obamacare — which Republicans tried unsuccessfully to repeal in 2017 — was a focal point for Democrats in the 2018 midterms when they took control of the House and scored significant wins in state and local elections.

“Tonight in federal court, the Trump administration decided not only to try to destroy protections for Americans living with pre-existing conditions, but to declare all-out war on the health care of the American people,” House Speaker Nancy Pelosi said shortly after the administration’s filing.

Trump on Tuesday didn’t directly mention the court filing when he spoke to reporters at the U.S. Capitol after leaving a lunch meeting with Republican senators. But he again hinted at a promise of a replacement that has so far not materialized in the years that the GOP has been vowing to repeal Obamacare.

“The Republican Party will soon be known as the party of health care,’’ Trump said.

While the Fifth U.S. Circuit Court of Appeals in New Orleans that’s handling the matter is known for its conservatism, Congress’s decision in 2017 to remove the penalty for not having coverage means Texas and its allies could have problems proving any harm to give them grounds for their challenge. That would put the issue firmly back in the hands of Congress.

The administration’s move comes as the White House is celebrating Attorney General William Barr’s review of the long-awaited findings by Special Counsel Robert Mueller, which he reported didn’t find evidence to show the Trump campaign conspired with Russia to meddle in the 2016 election.

Senate Minority Leader Chuck Schumer, a New York Democrat, said the Justice Department decision “will prove far more detrimental” to the Republicans than any political “gains” they might enjoy from the end of Mueller’s investigation.

Democratic strategist and campaign veteran Jesse Ferguson said Trump’s party “lost the midterms” as a result of its position on health care. Exit polls published by CNN found that health care was the top issue for 2018 voters in House elections across the country. The 41 percent who cited it preferred Democratic candidates over Republicans by a jarring margin of 75 percent to 23 percent.

Yet it’s an issue Democrats have struggled to stay focused on after taking the House in January and effectively neutering the Republican threat to repeal the 2010 law. Trump’s vow to repeal the law was a central promise of his 2016 campaign.

Democratic National Committee Chairman Tom Perez said Tuesday the filing moves Republicans “one step closer to throwing the financial security and peace of mind of millions — not to mention one of the largest sectors of our economy — into a tailspin.”

The Affordable Care Act has extended coverage to about 20 million Americans through private insurance marketplaces and an expansion of Medicaid. It has long been a target of conservatives for its tax hikes, regulations and new spending, which they argue have exacerbated flaws in the health care system.

Texas and the states that joined in the suit assert that because Congress in 2017 zeroed out the tax penalty for violating Obamacare’s individual mandate to buy insurance, the measure is no longer constitutional, and that the rest of the law is “inseverable” from it and “therefore invalid.”

Several states, including California, New York, Illinois, Connecticut and Virginia have intervened in the suit to keep Obamacare intact.

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