The Trump administration's recent shift to full support of a lawsuit filed by 20 Republican attorneys general and governors seeking to have the entire Affordable Care Act declared unconstitutional is a legal absurdity and a wantonly cruel and reckless policy decision. The plaintiffs argue, and the Trump administration now agrees, that the entire ACA became unconstitutional when Congress reduced the individual mandate penalty to zero in late 2017, because the Supreme Court in 2012 held that the mandate was Constitutional only as an exercise of Congress's taxing power. That is rank sophistry rejected by attorneys and legal scholars across the political spectrum -- suggesting in effect that the Republican Congress repealed the ACA by accident when it zeroed out the mandate penalty as part of the tax package passed in December 2017 after failing in multiple attempts to repeal the law's core programs earlier that year.
Full repeal by judicial fiat would swiftly deprive tens of millions of health insurance gained through the ACA Medicaid expansion and in the ACA marketplace. ACA nullification would weaken protections for more than 150 million Americans insured through employers, nullify the ACA's guaranteed access to the individual market for some 130 million Americans with pre-existing conditions, and subject seniors to thousands of dollars in out-of-pocket costs for prescription drugs. Repeal would wipe out Medicare payment reforms that have slowed the growth of healthcare costs and would drive rural hospital closures with sudden increases in uncompensated care. The ACA is deeply embedded in every aspect of the United States' health care delivery system. Voiding the entire law would wreak incalculable havoc.
Also recently, House Democrats introduced legislation that would strengthen the ACA and reduce the ranks of the uninsured and under-insured. This "ACA 2.0" bill, introduced by House Energy and Commerce Committee Chairman Frank Pallone (NJ-6) would reduce premiums for comprehensive coverage at every income level, capping premiums in the ACA marketplace as a percentage of income for all who lack access to affordable insurance elsewhere. It would also reduce marketplace premiums through federally funded reinsurance; require the federal government to invest in enrollment assistance and advertising; restore restrictions on lightly regulated short-term plans; extend eligibility for subsidies to those whose employers offer family coverage that is not readily affordable; and fund state initiatives to further improve healthcare access and affordability.
BlueWaveNJ strongly supports this common sense effort to build on the experience of ACA implementation and improve the program based on that experience, as is essential for all major legislation. As Democrats develop plans and debate approaches to further health care reform in preparation for taking power in 2021, defending and improving the ACA to the extent possible in the interim should be a matter of consensus. We also call on members and the progressive community to give voice to the strong majority position of the American people that the gains in health care access achieved by the ACA must be protected and built upon, not torn down in an act of partisan spite and legal chicanery.