WASHINGTON — A move by the Trump administration aimed at striking down the Affordable Care Act thrust the partisan battle over health care into the middle of the 2020 campaign on Tuesday, handing Democrats a potential political gift on an issue that damaged Republicans in last year’s midterm elections.
In a new court filing, the Justice Department argued that the ACA, also known as Obamacare, should be thrown out in its entirety, including provisions protecting millions of Americans with pre-existing health conditions and allowing young adults to stay on their parents’ health care plans.
President Donald Trump praised the move during a lunch with Senate Republicans, and he suggested that the GOP should embrace a new congressional battle over health care policy ahead of the 2020 elections.
“Let me tell you exactly what my message is: The Republican Party will soon be known as the party of health care,” he told reporters before the lunch. “You watch.”
But neither the White House nor Republicans in Congress have offered a new plan to replace the comprehensive Obama-era law, which was passed nearly a decade ago and has grown in popularity since Trump was elected.
Democrats immediately seized on the administration’s filing, calling it the latest attempt by Republicans to strip health insurance from Americans. House Speaker Nancy Pelosi, D-California, on Tuesday also unveiled Democratic plans for further bolstering the ACA.
“Trump and his administration are trying to take health care away from tens of millions of Americans — again,” Sen. Kamala Harris, D-California, said on Twitter, one of several tweets by presidential candidates criticizing Trump about health care. “We must fight back again with everything we’ve got. And in 2020, we need to elect a president who will make health care a right.”
As recently as November, after Democrats won control of the House of Representatives in an election dominated by the health care issue, Republican congressional leaders had suggested that they planned to move on from their yearslong efforts to repeal Obamacare.
But Trump suggested that he wants to revisit the issue, after two unsuccessful 2017 efforts to undo former President Barack Obama’s signature legislative achievement. Trump has long fumed over those failures and, as recently as last week, has attacked the late Sen. John McCain, R-Arizona, for his pivotal role in quashing the effort.
Trump spent much of his time at the Senate lunch talking about health care, according to several senators present.
“If there’s a message to be learned from 2018 on policy, it’s health care,” Sen. Lindsey Graham, R-South Carolina, told reporters after the lunch Tuesday. “Let’s become the party of health care.”
“He thinks that that’s the one area where we’ve fallen short and he wants to see us address it,” said Sen. John Kennedy, R-Louisiana. “He made that very clear.”
But by resurfacing old battles about stripping away popular elements of the current health care system, Trump is likely to embolden and unite Democrats who seek to make health care a top issue in 2020, said Amy Walter, national editor of the Cook Political Report. Democrats who have been divided in recent months over proposed “Medicare for all” legislation can now coalesce around the idea of protecting the ACA’s most popular provisions, she said.
“If you’re a Republican thinking about 2020 right now, you want to be on offense on health care, not defense,” she said. “And the only way to do that is to make the focus on what Democrats want to do — on Medicare for all – rather than making it on what the president and the White House are suggesting.”
The president’s comments at the Senate lunch came after the Justice Department supported invalidating Obamacare in a legal filing Monday with the U.S. Court of Appeals for the 5th Circuit in New Orleans, where an appeal is pending in a case challenging the law’s constitutionality. A federal judge in Texas ruled in December that the law’s individual mandate “can no longer be sustained as an exercise of Congress’s tax power” and further found that the remaining portions of the law are void. He based his judgment on changes to the nation’s tax laws made by congressional Republicans in 2017.
Republican senators offered differing responses to the administration’s new court filing, though none offered support for throwing out all of Obamacare without a ready replacement for its most popular elements.
Sen. Susan Collins of Maine, a moderate Republican who has voted against bills dismantling the ACA, said Tuesday that she was “very disappointed” in the administration’s legal position.
“It is highly unusual for the Department of Justice not to defend duly enacted laws, which the Affordable Care Act certainly was,” Collins said. “This decision to even go more broadly in failing to defend the law is very disappointing.”
Some Republican senators downplayed the idea that the 2010 health care law was immediately at risk, and they said they would work to make sure those with pre-existing conditions would be protected no matter what.
Sen. Josh Hawley, R-Missouri, who backed previous lawsuits seeking to deem the Affordable Care Act unconstitutional, said he still supported eliminating the law.
“I think Obamacare should be gone,” he said. “We’ve got to cover people with pre-existing conditions apart from Obamacare, which is what I talked about a lot.”
The fate of Obamacare could — once again — hinge on the Supreme Court, which has installed two new conservative justices since it voted to uphold the landmark health care law in 2012.
If the courts were to overturn the ACA, about 20 million Americans would lose their health coverage, according to an analysis by the Urban Institute. The coverage gains were chiefly through the offer of private, subsidized plans in state-based marketplaces and through the expansion of Medicaid in many states to people earning up to 138 percent of the federal poverty level.
There would be ripple effects throughout the health care industry and insurance landscape. Those with workplace plans could be affected; employers would be allowed to scale back certain medical benefits, and people with pre-existing conditions buying coverage on their own would no longer be guaranteed access to coverage at no extra cost.
Democrats were eager to highlight the potential damage from a ruling to strike down Obamacare — and to change the subject after a summary of special counsel Robert Mueller’s findings did not establish that Trump’s campaign colluded with Russia during the 2016 election. Some pointed out that relentless focus on health care helped Democrats win control of the House last year.
“I just won my Senate race, and I talked about health care a lot,” said Sen. Tim Kaine, D-Virginia.
While many Democratic presidential candidates have embraced health care proposals that go beyond the Affordable Care Act to offer universal coverage, defending the law against Republican efforts to dismantle it has been a potent rallying cry and an effective unifying tool.
Sen. Bernie Sanders, I-Vermont, has frequently emphasized his support for Medicare-for-all in his presidential campaign, but on Tuesday he sought to defend Obamacare from the Trump administration.
“Our goal is to pass Medicare for all and make health care a right,” he wrote on Twitter. “Today our job is to defend the Affordable Care Act from relentless attacks by the Trump administration.”
Sen. Elizabeth Warren, D-Massachusetts, is frequently asked during town hall meetings about health care, a topic that has come up about a dozen times at events across the country, according to a tally by her presidential campaign. Warren supports Medicare-for-all, and she has spoken in favor of protecting Obamacare.
“I’ll say it for the zillionth time: We will not let the Trump administration rip health care away from millions of Americans,” she said Tuesday on Twitter. “Not now. Not ever.”
Washington Post writers Sean Sullivan and Paige Winfield Cunningham contributed to this report.