Mar 3, 2020 - Health

The Supreme Court could be Trump's ACA nightmare

Illustration showing a red cross in the shadow of a gavel
Illustration: Sarah Grillo/Axios

The Supreme Court’s next big Affordable Care Act case could be a huge political problem for President Trump.

Why it matters: The Trump administration will spend the next several months urging the court to strip away some 20 million people’s health insurance and to throw out protections for pre-existing conditions. And it may all come to a head just before Election Day.

Driving the news: The court said yesterday that it will hear the challenge filed by Republican attorneys general, and supported by the Trump administration, that aims to strike down the entire ACA.

  • The move was a surprise: Machinations in the lower courts had seemed likely to push a Supreme Court appeal well past the election.

What’s next: Oral arguments in the case haven’t been scheduled yet, but following the court’s standard timeline, there’s a decent chance those arguments could fall in October — just weeks, or potentially even days — before Election Day.

  • Election-eve arguments over the fate of 20 million people’s health care coverage would be a particularly great gift for Democrats, but even if they fall after Nov. 3, this case is still a gift.

Where it stands: Polls consistently show that health care is among voters’ most important issues in 2020, and if this case becomes a big part of that debate, it's likely to disproportionately benefit Democrats.

  • Opposition to the health care law doesn’t rile up the Republican base the way it used to.
  • But as we saw during the repeal-and-replace saga of 2017 and then in the 2018 midterms, threats to those protections definitely motivates Democrats.
  • The ACA as a whole is now popular, and some of its main provisions — like guaranteed coverage for people with pre-existing conditions — have always been popular.

The Justice Department has been advocating for the end of the ACA for almost a year and had urged the courts to strike down protections for pre-existing conditions before that. But the case, despite its implications, hadn’t really penetrated the 2020 conversation so far.

  • That’s likely to change as we head into a general election with a Supreme Court case looming.
  • Trump has repeatedly brushed aside questions about pre-existing conditions, saying his administration will protect patients who have them.
  • But neither the White House nor congressional Republicans have ever put forward a plan that would ensure the same level of protection as the ACA.

Reality check: This will be the third time the Supreme Court has held the ACA’s life in its hands.

  • And though the court has gotten more conservative over that time, all five of the justices who voted to uphold the law in 2012 are still there.

The bottom line: “Regardless of the date of oral argument, the Democratic candidate will — and should! — use this case to bludgeon President Trump at every turn,” University of Michigan law professor and ACA legal guru Nicholas Bagley tweeted.

Go deeper