President Trump’s administration hasn’t lacked for innovative ways to disrupt the Affordable Care Act. Now it’s found another.
Facing a federal lawsuit from Texas and several other red states who want the entire law overturned, the Justice Department announced late Thursday that it won’t defend a core ACA provision in court: the guarantee of coverage for preexisting conditions. In a legal filing, the department essentially agreed with much of the lawsuit’s rationale, which is that recent legislation has voided most of the ACA’s most important provisions. While it’s unclear whether this unusual decision by the DOJ will help the lawsuit’s chances, it is yet another signal that the ACA remains vulnerable to being dismantled in pieces.
The filing originates in the complicated and sometimes perplexing legal history of the ACA. When the reform was passed in 2010, it contained a set of complex provisions involving private health insurance, including new subsidies for the purchase of private insurance and new marketplaces for the sale of private plans by insurers. Crucially, the law also created a series of rules enhancing the minimum level of coverage those plans could provide, including provisions that compelled insurers to cover people with preexisting medical conditions while keeping them from charging those people more. Finally, the law mandated individuals without insurance who could afford those private plans to purchase them or risk paying a tax penalty for going without insurance.