Republicans' ACA lawsuit could leave millions uninsured, reversing years of progress

Healthcare was the No. 1 issue for voters in the 2018 midterm elections, and the importance of the issue shows no signs of abating as we head toward the 2020 elections.

But while there’s been an important debate among Democrats and across the country about the best way to expand health coverage to even more Americans, President Donald Trump and Republicans have continued their campaign to sabotage the Affordable Care Act, jeopardizing healthcare and protections for millions of Americans who already have reliable insurance.

Through executive actions and rulemaking, the administration has cut the open-enrollment period, slashed resources for marketplace advertising and navigators, and allowed for state waivers that make it harder for people to get and keep comprehensive insurance coverage. States, with federal approval, have instituted draconian work requirements for Medicaid, shutting out some of the most vulnerable patients. As a result, under Trump, the number of Americans who are uninsured has risen by 7 million. Democratic efforts in Congress to reverse this trend have been stymied by Senate Majority Leader Mitch McConnell and the Republican Senate.

But what many Americans don’t realize is that the biggest threat yet to the Affordable Care Act is currently making its way through the court system—and it has the potential to overturn the law in its entirety.

In early July, the 5th U.S. Circuit Court of Appeals heard oral arguments in the Texas v. United States lawsuit to nullify the entire ACA. If successful, this lawsuit would rip away healthcare from 20 million people and leave 130 million more without protections for pre-existing conditions.

In short, a small number of Republican state attorneys general, with the support of the administration, are making the case that since Congress repealed the individual mandate, the remainder of the law cannot stand and should be invalidated entirely.

Of course, Congress explicitly kept the rest of the ACA while removing the mandate, so the president is asking the courts to overturn the clear will of Congress. Many legal scholars initially dismissed this argument as fringe. But last year a conservative U.S. District Court judge ruled in Republicans’ favor, and we’re currently awaiting the appellate court’s ruling sometime this fall. Whatever the court decides, there is a strong chance that the fate of the ACA will once again rest with the Supreme Court.

One thing is clear: Invalidating the ACA would be a humanitarian catastrophe.

Insurance coverage for 20 million Americans? Gone. Protections for people with pre-existing conditions that keep insurance companies from denying them care or charging them more? Gone. Requiring insurance companies to let young adults stay on their parents’ plans until age 26? Gone. Medicaid expansion coverage for 13 million people? Gone.

And that isn’t all. Invalidating the entire ACA would also send us back to the days when insurance companies could charge women 50% more than men. It would eliminate financial assistance that helps millions afford plans through the exchanges. And it would make it so that insurance companies no longer have to cover essential health benefits like prescription drugs or trips to the emergency room.

President Trump and congressional Republicans have been cheering this lawsuit on, despite the fact that they have absolutely no plan for what will happen if it succeeds.

There’s no denying that we need a robust debate within the Democratic Party about the future of healthcare in America. But the country cannot lose sight of the very real threats to coverage and protections for millions of Americans.

More commentaries from members of the 116th Congress on the state of healthcare