Justice Department takes aim at heart of health law

Trump justice department will stop defending key parts of Obamacare

Legal specialists also point out that the Trump administration's failure to defend the federal health law could have long-lasting implications for the rule of law in the nation. If the judge in the case agrees, millions of Americans with preexisting conditions could face denial of coverage or higher premiums.

At issue is a lawsuit filed by 20 Republican state attorneys general on February 26, which charged that Congress' changes to the law in last year's tax bill rendered the entire ACA unconstitutional.

It backs up their contention that the ACA provision requiring most Americans to carry health insurance soon will no longer be constitutional. In that, lawmakers made a decision to eliminate the tax penalty the ACA requires people to pay if they flout the insurance mandate.

Roberts wrote in a 5-4 ruling that the requirement for most Americans to either have insurance or pay a fine constitutes a tax - even though Democrats had gone to great lengths to not call it a tax - and was therefore constitutional. Because the individual mandate is essential to the operation of all of the other ACA provisions, Texas argued, the entire ACA must be invalidated.

"We strongly condemn the Administration's decision not to defend the patient protections provided in the Affordable Care Act, an established law of the land", APA President Altha Stewart, M.D. said.

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Becerra is leading an effort by Democratic attorney generals from others states and the District of Columbia to defend the ACA against that lawsuit.

On June 7, California and the other states with Democratic attorneys general filed their response to the preliminary injunction motion. The mandate has always been a sticking point for conservatives, who argue that the government should not be telling individuals what coverage they must have. Moreover, Congress had no intention of repealing the rest of the law when it eliminated the individual mandate in 2017. The court said that while this "individual mandate" exceeded Congress' power to regulate commerce, it could be upheld as an exercise of Congress' taxing power. Those include Congress' decision to repeal the individual mandate penalty and rules expected soon from the administration that will expand the market for lower cost and short-term policies that won't have to follow all the ACA rules.

What it means: If successful, the states' lawsuit would allow insurers to charge much higher rates to people with pre-existing conditions, or deny them coverage altogether, effectively ending the ACA's promise of providing health care for all Americans.

But the administration said the rest of the law, including Medicaid expansion, can remain in place.

"Withdrawing from a case en masse like this, right before the brief is filed, is unheard of", noted Nicholas Bagley, a former Justice Department lawyer who now teaches at the University of Michigan Law School. "I don't even understand what the legal argument would be", said Rep. Leonard Lance, R-N.J., one of the most endangered Republican incumbents in the midterms.

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The Texas case will be decided first by O'Connor, a conservative appointee of President George W. Bush.

Insurers, meanwhile, warned that the administration's actions could rock the individual market and could lead to higher premiums, especially for those battling illnesses.

Before the Affordable Care Act marketplace launched in 2014, people with chronic diseases who tried to buy their own insurance were routinely denied coverage based on their medical history. If these people lost or left their jobs, they may not be able to get individual market coverage.

More immediately, there might be some effect on premiums for next year. How are insurers to prepare for this unknown future? Until the Trump Administration (which is the target of the lawsuit) filed its views on Thursday, the case had been building without either side knowing what the government position would be. While the subsidies would not go away, it is unclear how their amount would be determined if insurers could return to the days before the law of charging higher prices to people with previous medical conditions - or refusing to cover them at all.More recently, the administration is in the midst of rewriting federal rules to make it easier for people to buy two types of insurance that are relatively cheap because they bypass the ACA's requirements for benefits that health plans sold to individuals and small business must include.

"Zeroing out the individual mandate penalty should not result in striking important consumer protections", the group said.

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