A Texas judge’s ruling that the Affordable Care Act is unconstitutional may not stand, but it will elevate health care as a pressing topic in a divided Washington.
WASHINGTON — The decision by a federal judge in Texas to strike down all of the Affordable Care Act has thrust the volatile debate over health care onto center stage in a newly divided capital, imperiling the insurance coverage of millions of Americans while delivering a possible policy opening to Democrats.
After campaigning vigorously on a pledge to protect patients with pre-existing medical conditions — a promise that helped return them to the House majority they had lost in 2010 — Democrats vowed to move swiftly to defend the law and to safeguard its protections.
On the defensive, Republicans campaigning this fall promised that they too backed the health law’s protections for people with pre-existing medical conditions. But the Texas ruling illustrated the fruits — and possible perils — of their long-running campaign, stepped up in the Trump era, to remake the judiciary through the confirmation of dozens of conservative judges, including two appointees to the Supreme Court.
The ruling, if it stands, would not only do away with coverage protections for people with pre-existing health conditions but would also strike down mandated coverage for what the law deems “essential health benefits,” including emergency services, maternity and newborn care, mental health and substance abuse treatment, prescription drugs and pediatric care.
But it is so sweeping that many legal analysts believe it is likely to be overturned. The Supreme Court, in a 5-to-4 decision, has already upheld the Affordable Care Act’s legality. The political reaction to the Texas decision, though, is not likely to diminish anytime soon.
“This is a five-alarm fire,” said Senator Christopher S. Murphy, Democrat of Connecticut. “Republicans just blew up our health care system.”
Republicans were muted in their response, but Representative Kevin McCarthy of California, the incoming House minority leader, appealed to Democrats to come to negotiate a successor to what he called “an unconstitutional law.”
“President Trump has made clear he wants a solution, and I am committed to working with my colleagues on both sides of the aisle to make sure America’s health care system works for all Americans,” he said in a statement Saturday.
The Democrats’ first step will be in the courts; aides to Representative Nancy Pelosi, the top House Democrat, said Saturday that House Democrats would move quickly to notify the Trump administration that they intended to intervene in the case. A vote on a resolution to do so is expected in the earliest days of the new Congress.
Democrats also intend to convene hearings to spotlight the sweeping impact of the Texas ruling — and lay the groundwork for their case to reclaim the White House in 2020. If upheld on appeal, the decision could deprive an estimated 17 million Americans of their health insurance — including millions who gained coverage through the law’s expansion of Medicaid. Still others could see premiums skyrocket as price protections for pre-existing conditions lapse.
The immediate practical effect of the ruling was not clear. While the judge declared that the whole law was invalid, as Texas and 19 other states had asserted, he did not issue an injunction to stop federal officials from enforcing it, and the effects of the judgment could be delayed pending appeals.
But the timing of the decision seemed designed to maximize political reverberations.
