Democrats Pivot Hard to Health Care After Trump Moves to Strike Down Affordable Care Act

WASHINGTON — A new fight over the future of the Affordable Care Act burst onto the Capitol Hill agenda on Tuesday morning, as Democrats tried to move past the Mueller report and pounce on the Trump administration’s legal motion to have President Barack Obama’s signature health care law invalidated by the federal courts.

“The Republicans did say during the campaign that they weren’t there to undermine the pre-existing condition benefit, and here they are, right now, saying they’re going to strip the whole Affordable Care Act as the law of the land,” Speaker Nancy Pelosi of California told reporters, just hours before Democrats were to unveil their own plan to lower costs and protect people with pre-existing conditions.

“This is actually an opportunity for us to speak to the American people with clarity,” Ms. Pelosi went on. “They say one thing and they do another. They say they’re going to protect pre-existing conditions as a benefit, and then they go to court to strip it and strip the whole bill.”

[Trump officials broaden attack on Obamacare, arguing courts should reject all of it]

For Democrats, the Justice Department motion to invalidate the health law could not have come at a more opportune time. With the special counsel’s report failing to find collusion between President Trump’s campaign and Russia’s efforts to influence the election, Ms. Pelosi — who was celebrating her birthday on Tuesday — was already pressing to move her party back to the kitchen-table issues that they believe will shape the 2020 campaign.

In 2018, Democrats campaigned — and won — on their pledge to keep the law’s protections for pre-existing medical conditions, and are planning to roll out their own health care agenda with much fanfare at a news conference on Tuesday afternoon. Representative Hakeem Jeffries of New York, chairman of the House Democratic Caucus, promoted the plan on Tuesday morning, while also accusing Republicans of “launching an assault on health care in the United States of America.”

House Republicans — who also campaigned on a pledge to protect people with pre-existing conditions — were far more eager on Tuesday to take an extended victory lap on the Mueller report than field thorny questions about an issue that helped cost them the majority.

“I haven’t read through what they — was it last night?” Representative Kevin McCarthy of California, the House Republican leader, said during his weekly news conference dominated by a series of long statements about the report. He added, “I think the president has always been very clear that he wanted to repeal Obamacare, and to put a system in that actually lowers the cost and protects individuals’ pre-existing conditions.”

The Democratic offensive came the morning after the Justice Department asked a federal court to strike down the law in its entirety. The administration had previously said that the law’s protections for people with pre-existing conditions should be struck down, but that the rest of the law, including the expansion of Medicaid, should survive.

If the appeals court accepts the Trump administration’s new arguments, millions of people could lose health insurance, including those who gained coverage through the expansion of Medicaid and those who have private coverage subsidized by the federal government.

“The Justice Department is no longer asking for partial invalidation of the Affordable Care Act, but says the whole law should be struck down,” Abbe R. Gluck, a law professor at Yale who has closely followed the litigation, said Monday. “Not just some of the insurance provisions, but all of it, including the Medicaid expansion and hundreds of other reforms. That’s a total bombshell, which could have dire consequences for millions of people.”

In addition to inciting a furor on Capitol Hill, the administration’s new position is also certain to take center stage as an issue in the 2020 elections. Democrats have been saying that Mr. Trump still wants to abolish the law, and they can now point to the Justice Department’s filing to support that contention.

The Justice Department disclosed its new stance in a two-sentence letter to the United States Court of Appeals for the Fifth Circuit, in New Orleans, and will elaborate on its position in a brief to be filed later.

In the letter, the Justice Department said the court should affirm a judgment issued in December by Judge Reed O’Connor of the Federal District Court in Fort Worth.

Judge O’Connor, in a sweeping opinion, said that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power” because Congress had eliminated the tax penalty for people who go without health insurance.

Accordingly, Judge O’Connor said, “the individual mandate is unconstitutional” and the remaining provisions of the Affordable Care Act are also invalid.

In its letter to the appeals court, the Justice Department said Monday that it was “not urging that any portion of the district court’s judgment be reversed.” In other words, it agrees with Judge O’Connor’s ruling.

But on Tuesday, after a closed-door meeting, Democrats were piling on. Representative Cheri Bustos of Illinois, who leads the Democrats’ campaign committee, was quick to note Republicans’ vote in January to back a lawsuit repealing the Affordable Care Act, saying “their actions speak much louder than their lies.”

Millions of hardworking families across America could see their health care costs explode because Washington Republicans sided with big insurance companies instead of everyday Americans,” Ms. Bustos added. “They simply cannot say they support protections for people with pre-existing conditions, lowering health care costs, or expanding access to care for more Americans, because they voted to destroy all of these things.

In the nine years since it was signed by Mr. Obama, the Affordable Care Act has become embedded in the nation’s health care system. It changed the way Medicare pays doctors, hospitals and other health care providers. It has unleashed a tidal wave of innovation in the delivery of health care. The health insurance industry has invented a new business model selling coverage to anyone who applies, regardless of any pre-existing conditions.

The law also includes dozens of provisions that are not as well known and not related to the individual mandate. It requires nutrition labeling and calorie counts on menu items at chain restaurants. It requires certain employers to provide “reasonable break time” and a private space for nursing mothers to pump breast milk. It improved prescription drug coverage for Medicare beneficiaries, and it created a new pathway for the approval of less expensive versions of biologic medicines made from living cells.

Lawyers said invalidation of the entire law would raise numerous legal and practical questions. It is, they said, difficult to imagine what the health care world would look like without the Affordable Care Act.

The Trump administration’s new position was harshly criticized by the insurance industry and by consumer advocates.

The government’s position “puts coverage at risk for more than 100 million Americans,” said Matt Eyles, the president and chief executive of America’s Health Insurance Plans, the industry lobbying.

Leslie Dach, the chairman of Protect Our Care, a consumer advocacy group, said: “In November, voters overwhelmingly rejected President Trump’s health care repeal and sabotage agenda. But he remains dead set on accomplishing through the courts what he and his allies in Congress could not do legislatively: fully repeal the law, devastate American health care and leave millions of Americans at risk.”

The Trump administration’s new stance appears to put Republicans in Congress in an awkward position. They have repeatedly tried to repeal the health law. But in the last year, they said over and over that they wanted to protect coverage for people with pre-existing conditions, and those protections are among the law’s most popular provisions.

The lawsuit challenging the Affordable Care Act, Texas v. United States, was filed last year by a group of Republican governors and state attorneys general. Officials from California and more than a dozen other states have intervened to defend the law.

The Texas lawsuit “is as dangerous as it is reckless,” Xavier Becerra, the attorney general of California, said Monday as he filed a brief urging the appeals court to uphold the law.