Donald Trump’s justice department will argue for the end of the Affordable Care Act (ACA) at the supreme court on Tuesday morning, threatening the healthcare of millions of Americans amid a global pandemic.
At risk in the case is the healthcare coverage of at least 20 million Americans and a number of popular protections which have shifted expectations regarding costs and how the country’s health system operates. The ACA, passed in 2010 and popularly known as Obamacare, allows people to access preventive health services such as vaccinations at no cost. It also caps insurer profits.
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 brought before a court with three justices appointed by Trump.
The case was a flashpoint in hearings for the newest justice, Amy Coney Barrett, who was confirmed to the court two weeks ago. She has made critical statements about the law, as has Trump appointee Brett Kavanaugh. But neither have shown they support for the legal argument at hand, that the entire ACA should fall simply because one part of the law is ruled unconstitutional.
Justice department lawyers and Republican state officials challenged the constitutionality of the individual mandate, a key part of the law, and argued the rest of its 2,000 pages of regulations must go down with it.
The individual mandate requires people to have health insurance or face a financial penalty. In 2017, Congress made the penalty zero dollars, sparking the lawsuit now before the court. Republicans say that change made the mandate unconstitutional and if the court agrees, the rest of the law should fall.
Though Republicans have consistently opposed the law, some of its provisions enjoy overwhelming support among Americans.
Before Obamacare, millions of Americans who had cancer, multiple sclerosis or other diseases could be denied healthcare coverage because of their condition. At least 54 million have a pre-existing condition which would have been deniable before the ACA.
In an October poll, while only 55% of Americans said they have a favorable view of the ACA, 79% said they did not want the court to overturn its protections for people with pre-existing conditions, according to the Kaiser Family Foundation.
Without that protection, people who contract Covid-19 could also be denied coverage, be charged higher premiums, or have future treatment for coronavirus turned down.
The lawsuit was brought by a coalition of states led by Texas and two individual plaintiffs. This group split argument time with the US justice department, which in June said it supported taking down the entire law.
The state of California and attorneys representing the House of Representatives defended the ACA in court.
Many conservative legal scholars have said the legal argument for dismantling the entire law is weak and during the Coney Barrett deliberations, several Republicans insisted the law would not be struck down.
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 strike down the Affordable Care Act.”