Trump administration's latest attack on Obamacare would gut protections for the sick

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The Trump administration's decision not to defend the Affordable Care Act in federal court in Texas on Thursday provides the latest challenge for NY insurers and regulators. The first, known as guaranteed issue, requires insurers to offer coverage to everyone regardless of their health background.

In its brief, also filed on June 7, the Justice Department abandoned its customary role of defending laws passed by Congress and took the side of Texas, agreeing that the mandate is now unconstitutional.

The overall ACA and the state-run marketplaces where subsidized health insurance is sold have continued to operate in the six years since the Supreme Court had upheld the individual-insurance mandate, but have often had difficulty holding down insurance premiums and have had a steady erosion of the number of insurance companies willing to continue to sell policies on those exchanges, even with subsidies that help them offset the cost of keeping premiums down.

The Trump administration's startling decision to abandon one of the Affordable Care Act's most popular provisions - protections for people with preexisting medical conditions - put Republicans on the defensive Friday and handed Democrats a potentially potent political message.

An NBC/Wall Street Journal poll released on Thursday - before the Trump administration decision was unveiled - found health care was the top issue for all voters and that it's an issue where Democrats have an overwhelming advantage.

The mandate in Obamacare was meant to ensure a viable health insurance market by forcing younger and healthier Americans to buy coverage.

The president last fall ended "cost-sharing reduction payments" to insurers that offset discounts that the law promises to lower-income customers in the out-of-pocket costs for ACA health plans.

SIMON: What other parts of the ACA does the Department of Justice single out in the lawsuit?

The states are now arguing that once Congress repealed the tax penalty for the individual mandate in the 2017 law, no more constitutional authority exists for Congress to keep the individual mandate in place.

But Marty Lederman, who worked in the Obama Justice Department and now teaches at Georgetown Law School, says the move was unprecedented. But previous year the Republican-controlled Congress eliminated those penalties as part of the $1.5 trillion tax overhaul that Trump signed in December.

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California and 15 other states filed an opposing brief on Thursday defending the law.

You may remember that the Obama team was anxious about the interaction between the individual mandate and the popular ACA provisions that say insurance companies can't refuse to cover anybody because of pre-existing conditions and can't charge you more if you are already sick.

The state has been at the forefront in resisting many Trump Administration policies, including on health care and immigration. Collins, who voted against the Republican bills to repeal the Affordable Care Act in the Senate past year, also expressed concern about the administration's new push to undo it. Conservatives at the time accused the Justice Department of politicization.

Sessions said the department was unable to find any "reasonable arguments" for the constitutionality of the consumer protection provisions and the department adopted the position "with the approval of the president of the United States".

Though the lawsuit has a long path before it, Democrats and their allies are seizing on the administration's stance as a ready-made attack line as they try to retake the House in November. "Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019", AHIP said in a statement. That will leave sicker people buying insurance.

Attorney General Jeff Sessions told congressional leaders in a letter about the Justice Department's stance in the case, and said it had been approved by President Donald Trump.

And though the federal government will apparently no longer defend a pillar of the law, a group of left-leaning states have stepped in to back it in court.

"I've long held a position that the federal government should get completely out of the health insurance business", he said.

Today, surveys suggest most Americans see the legislation in a generally positive light, a reversal from most of its eight-year history. Why it matters: Protections for people with pre-existing conditions are hugely popular, and the administration may have handed Democrats their strongest health care weapon yet - because now they can make the case that the administration has gone to court to take away protections for people with pre-existing medical conditions.

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