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Donald Trump’s justice department will advocate for an end to the Affordable Care Act (ACA) in supreme court Tuesday morning, threatening the health care of millions of Americans amid a global pandemic.
At risk in the case is health care coverage for at least 20 million Americans and a host of popular protections that have changed expectations regarding the costs and performance of the nation’s health system. The ACA, passed in 2010 and popularly known as Obamacare, allows people to access preventive health services such as vaccines at no cost. It also limits the profits of insurers.
In two previous challenges to the law, the supreme court has left the ACA largely intact. But the court now has a 6-3 conservative majority and this is the first major case to come before a court with three Trump-appointed judges.
The case was a high point in hearings for the most recent judge, Amy Coney Barrett, who was confirmed in court two weeks ago. He has made critical statements about the law, as has Trump appointee Brett Kavanaugh. But none have shown support for the legal argument in question, that the entire ACA should fall simply because part of the law is declared unconstitutional.
Lawyers for the Justice Department and Republican state officials challenged the constitutionality of the individual mandate, a key part of the law, and argued that the rest of its 2,000 pages of regulations should go with it.
The individual mandate requires individuals to have health insurance or face a financial penalty. In 2017, Congress imposed the penalty at zero dollars, prompting the lawsuit now in court. Republicans say the change made the mandate unconstitutional and if the court agrees, the rest of the law should fall.
Although Republicans have consistently opposed the law, some of its provisions enjoy overwhelming support among Americans.
Before Obamacare, millions of Americans with cancer, multiple sclerosis, or other diseases could be denied health care coverage because of their condition. At least 54 million have a pre-existing condition that would have been denied prior to the ACA.
In an October poll, while only 55% of Americans said they have a favorable opinion of the ACA, 79% said they did not want the court to revoke its protections for people with pre-existing conditions, according to the Kaiser Family Foundation .
Without that protection, people who contract for Covid-19 could also be denied coverage, charged higher premiums, or could be denied future treatment for the coronavirus.
The lawsuit was filed by a coalition of states led by Texas and two individual plaintiffs. This group divided discussion time with the US Department of Justice, which in June said it supported repeal of the entire law.
The state of California and the attorneys representing the House of Representatives defended the ACA in court.
Many conservative legal scholars have said that the legal argument for dismantling the entire law is weak, and during Coney Barrett’s deliberations, several Republicans insisted that the law would not be repealed.
In October, the nation’s highest-ranking Republican after Trump, Senate Majority Leader Mitch McConnell, said, “No one believes the supreme court is going to repeal the Affordable Care Act.”