The Trump Administration formally declared the Affordable Care Act — all of it, this time — unconstitutional on Wednesday. Taking a machete to the entire Obama-era law would wipe out coverage for pre-existing medical conditions, like pregnancy and cancer. It would also shred the Medicaid expansion program in multiple states that covers millions more.
Texas notoriously hasn’t expanded Medicaid. But in 2015, there were an estimated 4.5 million Texans who had pre-existing health conditions prior to the passage of the ACA. The Lone Star State remains the uninsured capital of the country.
Andy Slavitt, a progressive health care policy analyst and former head of the ACA in the Obama Administration, said on Twitter Trump “goes “further than ever before to dismantle the ACA in entirety.”
Texas as protagonist
Texas Republicans, from Gov. Greg Abbott to Attorney General Ken Paxton, have played – and continue to play — a leading role bludgeoning the ACA. That hasn’t stopped Texas Democrats from offering solutions and trying to get the embarrassing number of uninsured in the state some health coverage.
State Rep. Garnet Coleman of Houston filed a bill calling for Medicaid expansion – a nasty, dirty term in Texas – and would codify pre-existing medical conditions into state law. Another proposal puts Medicaid expansion on the ballot to let voters decide. (If polls are any guide, Texans would vote for it tomorrow.)
“Expanding Medicaid should be a no brainer,” House Democratic Caucus Chair and State Rep. Chris Turner wrote in March. “It would provide coverage for over 1 million Texans basically overnight and draw down billions of federal dollars in the process.”
It’s extremely unlikely any of these bills will see significant movement in the Legislature.
So now what?
The ultimate destination of any big ACA constitutional challenge is likely the U.S. Supreme Court – perhaps before the 2020 presidential election. The Justices aren’t immune to public sentiment on issues before the Court. And on the ACA, despite been beaten to a bloody pulp in the court of public opinion, the law it gets more popular. It ages well.
Another variable for the future of health care: the winners of the 2020 presidential and congressional elections. Whether the Court takes the case or not, the next president will determine the future of health policy in the United States.