The filing declares unconstitutional the so-called individual mandate-which requires nearly all Americans to purchase health insurance or pay a "tax" if they don't-and calls for several elements of ACA to be invalidated.
"In refusing to follow bipartisan tradition and defend the ACA in the USA federal court system, the Trump administration is nakedly admitting that it wants to eliminate protections for people with pre-existing conditions, breaking a promise that the president has made time and again", said Topher Spiro, vice president of health policy at the Center for American Progress. Texas and other Republican-led states are suing to strike down the entire law because Congress recently repealed a provision that people without health insurance must pay a fine.
The lawsuit, filed in February by Texas and other GOP-led states, is in many ways a replay of the politically divided litigation that ended with the Supreme Court upholding the health care overhaul in 2012.
According to the AP, the administration said it agrees that the law's individual mandate is unconstitutional without the fine and that language protecting those with medical conditions from being denied coverage or charged higher premiums should also be struck down. However, if the federal court sides with the plaintiffs, those with pre-existing conditions could once again be denied coverage. That means consumer insurance protections under the law are not valid either, the brief argues. On his first night in office, Trump issued an executive order, directing federal agencies to lighten the regulatory burden placed by the law.
More than one in four adults under the age of 65 have existing medical conditions, according to Kaiser Family Foundation. That ruling hinged on the reasoning that, while the government "does not have the power to order people to buy health insurance", as Chief Justice John Roberts wrote for the majority, it "does have the power to impose a tax on those without health insurance". States such as California will take up the law's defense, and the legal battle will continue.
Three attorneys for the government withdrew from the case just minutes before the Justice Department's filing in federal court in Fort Worth, Texas, which signaled an internal rift within the administration over its role in defending USA law, according to University of Michigan Law Professor Nicholas Bagley. For instance, it did not go after the creation of health insurance marketplaces, premium subsidies for low-income members and Medicaid expansion.
The administration called on the court to declare the provisions that guarantee coverage to be invalid beginning on January 1, 2019, when the mandate penalty goes away.
America's Health Insurance Plans, the main industry trade group, bemoaned the Justice Department's stance, saying it could upset a market that is becoming "more steady" for most consumers. Experts believe that could entice healthier people to exit the marketplace in favor of less-expensive, short-term plans, leaving the marketplace with a sicker population that could drive insurance costs higher. Tom Miller of the American Enterprise Institute told Politico that the refusal to defend key parts of the ACA shows that the Trump administration is going even further in its battle against the health care law. "Such withdrawals are exceedingly rare - typically only when the argument is indefensible, as they are here".