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March 29, 2019

Trump promises health law 'far better than Obamacare' if law is struck down, but provides no details

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    President Trump on Wednesday said Republicans will "have a plan that is far better than Obamacare" if the Supreme Court strikes down the Affordable Care Act, Roll Call reports.

    The question of whether the ACA should be invalidated is not currently before the Supreme Court, but legal experts predict a case challenging the law's constitutionality is likely to wind up on the justices' docket.

    Your cheat sheets for understanding health care's legal landscape

    About the case

    The case was filed by a group of attorneys general (AGs) from 20 Republican-led states in February 2018, who argued that because a 2017 tax reform law set the ACA's individual mandate tax penalty to $0, the individual mandate could no longer be considered a valid use of Congress' taxation authority. Further, they argued that the ACA cannot be severed from the mandate, meaning the entire health reform law is unconstitutional.

    U.S. District Judge Reed O'Connor in December 2018 agreed with the plaintiffs and ruled that eliminating the individual mandate's tax penalty rendered the mandate unconstitutional, and without the individual mandate the entire ACA must be struck down.

    Democratic AGs from 18 states and the District of Columbia, which are defending the ACA in the case, appealed O'Connor's ruling to the 5th U.S. Circuit Court of Appeals. On Monday, parties in the suit filed their initial briefs with the appeals court—and the Department of Justice  (DOJ), which has declined to defend the ACA in the suit, shocked observers by changing its position on the severability clause, arguing that the entire law should be struck down along with the individual mandate.

    Trump says Republicans will have a plan—but GOP lawmakers don't currently have one

    Trump commented on DOJ's latest brief during an unrelated event in the Oval office, telling reporters, "Obamacare is a disaster. It's too expensive by far."

    Trump continued, "We're coming up with plans. ... And if the Supreme Court rules that Obamacare is out, we will have a plan that's far better than Obamacare."

    However, Republicans in 2017 were unable to come up with the votes to pass a bill that would repeal and replace the entire law—and they have made little progress on a new proposal since then.

    When asked about Trump's comments on a new repeal plan, Senate Majority Whip John Thune (R-S.D.) suggested that any bill to fully replace the ACA would come in part from Trump's administration. "We'll see what he puts forward and his team," Thune said.

    Senate Committee on Health, Education, Labor, and Pensions Chair Lamar Alexander (R-Tenn.) said he was not aware of a broad plan to replace the ACA, but suggested there would be a way to maintain the law's protections for individuals with pre-existing medical conditions.

    "The one thing I'm sure of, if that should happen—and we're certainly a long way from there—and if [it] had any effect on protecting Americans with pre-existing health conditions, there would be an immediate plan to replace that," Alexander said.

    Sen. Chuck Grassley (R-Iowa) said, "We would have to act accordingly" if the Supreme Court strikes down the ACA. But he also noted it could take several months for the case to reach the Supreme Court and for the justices to issue a final decision.

    Democrats seek to shore up ACA

    Senate Minority Leader Chuck Schumer (D-N.Y.) on Wednesday said he planned to introduce an amendment to a $13.45 billion disaster aid package that would prevent DOJ "from using any funding to litigate the downfall of the [ACA] in the Circuit Court."

    Schumer called DOJ's change in legal stance "a moral and institutional outrage."

    However, Senate Majority Leader Mitch McConnell (R-Ky.) on Thursday took procedural steps to block any additional amendments to the bill, Politico reports (Bennett/Lesniewski, Roll Call, 3/27; Cornwell, Reuters, 3/27; Everett, Politico, 3/27; Mejdrich, Roll Call, 3/27; Levine, Politico, 3/28).

    Cheat sheet: What you need to know about the ACA


    The Patient Protection and Affordable Care Act, otherwise known as the ACA, is the comprehensive health care reform bill passed by Congress in March 2010. The law reshapes the way health care is delivered and financed by transitioning providers from a volume-based fee-for-service system toward value-based care.

    Download the ACA cheat sheet to get a quick overview of this significant U.S. health care legislation.

    Get the Cheat Sheet

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