House Democrats defend Obamacare as courts weigh in

WASHINGTON – House Democrats ramped up their defense of Obamacare on Wednesday, one of their first actions after midterm elections in which they won the House after pounding away on the issue of health care.

Democrats will vote to authorize House attorneys to oppose a challenge to the Affordable Care Act by Republican attorneys general. A Texas judge recently agreed with the attorneys general that the landmark health care law is unconstitutional.

Democrats made lowering prescription drug prices a top priority, one of the few issues on which they could find common ground with Republicans who control the Senate and White House. On another health care issue, Medicare for all, they face debate even within their own ranks on how far to go.

Though prospects for legislative action are uncertain in a divided government, there is plenty going on in the courts this month that could affect people’s insurance coverage.

The Trump administration’s provision to make it easier for employers to exclude contraceptive coverage from insurance plans will go into effect Jan. 14 unless a judge intervenes. Courts are considering challenges to other ACA changes that the administration argued would give consumers more choices but that critics said would make insurance more expensive for those who need care.

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Here’s a look at where things stand:

Obamacare challenge

Judge Reed O’Connor, a U.S. District Court judge in the Northern District of Texas, ruled in December that the entire ACA is invalid. He said the Republican tax cut bill knocked the constitutional foundation out from under Obamacare by eliminating the penalty for not having coverage. The law, which remains intact during the appeals process, created not just the controversial Obamacare insurance plans but also many popular provisions in jeopardy such as protections for people with pre-existing conditions, an expanded drug benefit for seniors and coverage for young adults under their parents’ insurance plans.

House Democrats joined Democratic attorneys general in defending the law. University of Michigan law professors Nicholas Bagley and Richard Primus argued that the best way for Democrats to stop the latest ACA challenge is through legislation. Congress could make explicit what was implicit in the removal of the penalty for being uninsured – that the ACA does not hinge on a mandate to buy insurance.

Trumpcare challenges

After congressional Republicans failed to repeal the ACA, the Trump administration tried to write rules on its own. One would dramatically expand the ability of employers to exclude contraceptive coverage in insurance plans for religious reasons. Attorneys general from California, Pennsylvania and some other states are trying to keep the rule from going into effect Jan. 14.

Democratic attorneys general, consumer activists and others sued to stop the administration from expanding access to association health plans and to short-term coverage. The administration said consumers need alternatives to Obamacare plans, which can be expensive, especially for those who don’t qualify for subsidies. Opponents said that because the alternatives have fewer consumer protections and benefits, they would siphon healthy customers out of the Obamacare market – increasing the premiums for everyone left. In a letter sent to the White House Tuesday, congressional Democrats asked for more information on the proposed short-term plans – which they argued would not be legal.

Prescription drug prices

Following through on Trump’s promise to reduce the cost of prescription drugs, the administration rolled out various proposals that analyst Rachel Sachs of Washington University in St. Louis said range from radical to more modest ideas. Most remain in draft form, Sachs wrote in a piece for the policy journal Health Affairs.

House Democrats named tackling drug prices as one of their top legislative priorities. Proposals include long-standing Democratic plans to allow Medicare to negotiate for lower drug prices and newer ones that would require the government to make generic medicines. Sen. Bernie Sanders, I-Vt., even has a proposal that takes the same approach as a Trump administration plan – lowering prices by tying them to what other countries pay.

Medicare for all

A single-payer system such as Medicare for all is a popular rallying cry among liberals. Trump tried to defeat Democrats during the midterm elections by claiming it was “just the beginning” of the party’s “socialist agenda.”

House Speaker Nancy Pelosi, D-Calif., faces a balancing act in letting the more liberal members of her caucus explore the idea without it becoming a political albatross for the 2020 elections. She gave the green light for hearings to be held, but she cautioned that the proposal needs to be evaluated in terms of costs and benefits.