Congress was ready to move on from Obamacare.
The midterm elections took repeal off the table, and Democrats were gearing up for a party-defining fight over “Medicare for All.” But Friday night’s ruling by a federal judge in Texas that the Affordable Care Act must be scrapped once again puts the law front and center when Democrats take back the House just weeks from now.
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The ruling is sure to be appealed, and the Trump administration says it’s business as usual in the meantime. But the decision spells bad news for Republicans, by allowing Democrats to replay a potent health care message that helped them flip 40 House seats: the GOP remains hellbent on gutting Obamacare and rolling back protections for pre-existing conditions.
“Republicans are never going to give up on trying to take away health care,” Sen. Chris Murphy (D-Conn.) told POLITICO. “And it’s hard to figure out how Trump and Mitch McConnell would come up with any strategy to put the pieces back together.”
Republicans have been on the defensive since their repeated efforts to dismantle Obamacare while having full control of the government failed. While President Donald Trump and lawmakers like incoming House Minority Whip Steve Scalise (R-La.) cheered the development, some in the party called for bipartisanship to address the failings of the country’s health care system.
“We have a rare opportunity for truly bipartisan health care reform that protects those with pre-existing conditions, increases transparency and choice, and lowers costs,” said Rep. Greg Walden, the current chairman of the Energy and Commerce Committee, in a statement.
But that doesn’t appear likely if Friday’s ruling is working its way through the courts during the 2020 election cycle. House Democrats had long planned to intervene in the lawsuit on behalf of the ACA and will likely introduce a resolution directing the House counsel to defend the law during the first days of the new Congress. People familiar with the conversations say the Democrats will quickly put it to a floor vote that will force GOP lawmakers to either signal support for Obamacare or endorse its elimination — along with the law’s most popular patient protections.
Trump and other key Republicans’ hailing of the ruling as vindication of their belief that the law is unworkable and needs to be jettisoned also doesn’t set a constructive tone, said Rodney Whitlock, a former top Republican Senate health care staffer.
“He’s got to lead,” Whitlock said of the president. “I don’t think you’ll see congressional Republicans wanting to go that route when it’s far from clear that they’d have support from 1600 Pennsylvania Ave.”
The result is likely to be a split GOP caucus that draws flak from both the right and the left. Republicans who survived the midterm election by vowing to protect people with pre-existing conditions will find themselves in a particularly tough spot, feeling intense pressure to make good on that pledge.
“It’s all the downsides,” a House GOP aide said. “Politically, I don’t think that it helps us at all.”
But Democrats will face their own reckoning. Liberals were eager to push the debate forward on health care and put universal coverage through a government-run system at the center of the 2020 campaign.However, the renewed threat to the ACA’s survival is certain to keep the focus on the current law, and require Democrats to devote the next several months to protecting Obamacare’s coverage gains.
Already, Democrats are exploring how their GOP repeal message will play against Senate Republicans up for re-election in 2020. Those lawmakers voted to gut Obamacare’s individual mandate as part of the tax bill, argued Brad Woodhouse, executive director of the pro-Obamacare group Protect Our Care, effectively laying the groundwork for the Texas lawsuit’s winning argument.
“In some ways this starts not just the legislative discussion around health care for 2019 and 2020, but it also starts the political discussion,” Woodhouse said, ticking off a list of 2020 Republican targets that included Sens. Cory Gardner of Colorado, Joni Ernst of Iowa and Susan Collins of Maine, along with Trump.
The ruling came just over a day before the deadline for people to sign up for Obamacare coverage for 2019. Enrollments heading into the last week were down roughly 10 percent, sparking concerns among the law’s supporters that the Trump administration’s policies — including gutting marketing and outreach efforts — are further undercutting the law.
The legal fight ahead is sure to intensify anxiety for health care groups with a stake in Obamacare. They’ve already navigated the disastrous initial rollout of HealthCare.gov, incessant regulatory and legislative changes, failed repeal efforts and eight years of court battles.
“Sadly, we have seen this movie before,” said Ceci Connolly, CEO of the Alliance of Community Health Plans. “It is uncertainty that leads to instability and, in this situation, potentially chaos.”
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