The Justice Department told a federal court on June 6 that it would no longer defend key parts of the Affordable Care Act (ACA), including the individual insurance mandate and provisions that protect people with pre-existing conditions, saying they are part of an unconstitutional scheme. The Justice Department made the announcement through a brief filed in a federal court case brought by the state of Texas and 19 other states against the ACA and all of its ensuing regulations, and in a separate letter from Attorney General Jeff Sessions to congressional leaders. Specifically, the Justice Department stated that protections for people with pre-existing conditions are inseparable from the individual insurance mandate, which was repealed under the tax reform law enacted at the end of 2017, therefore these elements of the ACA must also be struck down.

The Department stated that other parts of the ACA, such as the health insurance premium subsides for consumers and the Medicaid expansion can continue to operate without the insurance mandate. The state of California and fifteen other states filed a brief in the case in support of the ACA. A final court ruling and appeals of any decision could delay action for at least several months, but if the federal court agrees with the Justice Department's argument, it could derail crucial parts of the ACA and allow insurers to reject coverage for people because of their medical conditions and charge people with pre-existing conditions higher insurance premiums. 

The Justice Department’s recent announcement adds to a series of actions that the Trump administration has taken to undermine the ACA, including repeal of the individual mandate, refusal to pay insurer cost-sharing reductions, new regulations permitting cheap short-term insurance plans, as well as state flexibility in designing insurance plans and essential health benefit coverage. As a result of these developments, health insurance premiums rose in 2018 and are expected to rise higher in 2019, when the new regulations take effect, as younger healthier people move to cheaper, less comprehensive plans, leaving a pool of sicker more expensive consumers for insurers to cover. The ATS will continue to monitor this court case and administration and congressional actions regarding the ACA closely and will take action to defend patient protections as needed.