President, Declaring He Now Understands Healthcare, Moves to Gut ACA

The Trump administration last week asked a U.S. Appeals Court to strike down the entire Affordable Care Act (ACA).
The decision brought immediate condemnation from hospital and healthcare interests.
MHA President & CEO Steve Walsh said, “Improving healthcare delivery is a shared goal and an evolving process. But this effort to dismantle the ACA rather than make thoughtful changes to our existing system of care is an extraordinarily shortsighted and harmful move that will create long-lasting repercussions for patient coverage and access.”
American Hospital Association (AHA) President Rick Pollack said, “Millions of Americans would lose the coverage they have relied on for years. We have made too much progress in coverage and access to care for patients to go backwards. If courts were to adopt the [U.S. Department of Justice] position, Medicaid expansion would be reversed and protections for people with chronic and pre-existing conditions would cease to exist.”
The Fifth Circuit Court of Appeals is reviewing last year’s decision from a U.S. District Court judge in Texas that struck down the ACA. Twenty-one Democratic Attorneys General, including the commonwealth’s AG Maura Healey, are appealing that ruling. The Democratic-controlled U.S. House of Representatives also filed a brief in support of the ACA. AHA plans to file an amicus brief today, urging the Court of Appeals to reject the lower court’s decision. Also a group of 26 state hospital associations, including MHA, are filing an amicus brief urging the Court of Appeals to reverse the district court’s order.
Last week’s filing by the Trump Administration’s Justice Department asks the Appeals Court to let the lower court ruling that gutted the ACA stand. The DOJ position surprised many because last year the Justice Department argued against the pre-existing portion of the ACA but endorsed retaining the bulk of the law.
President Trump last Wednesday said of the DOJ filing, “I mean it 100 percent, I understand healthcare now, especially very well. A lot of people don't understand it – we are going to be, the Republicans, the party of great healthcare.”
In 2017, Congress struck down one element of the ACA that imposed a tax penalty on those who chose to maintain healthcare coverage. Those who brought suit against the ACA in Texas argued, essentially, that Congress’ no-tax action turned the ACA’s remaining minimal coverage provision into a stand-alone and, ultimately, unconstitutional command to buy insurance. The 21 AGs rejected that argument in their brief last week, arguing, among other points, that the plaintiffs don’t have standing “because they suffer no legal harm from the existence of a provision that offers them a lawful choice between buying insurance or doing nothing.”
The DOJ announcement is not expected to affect the timeline of the appeals process, which will continue with arguments taking place sometime in mid-to-late 2019. A decision is expected in either late 2019 or early 2020.