A family practice provider uses a stethoscope to examine a patient in an exam room.
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Trump’s war against the ACA reaches a new, striking level

Shortly before the 2018 midterm elections, Donald Trump tried something odd, even by this president’s standards: he tried to tell voters that when it came to health care benefits, Republicans were actually more liberal than Democrats. “Republicans will totally protect people with Pre-Existing Conditions,” the president tweeted two weeks before Election Day. “Democrats will not!”

The claim was hopelessly bonkers for a variety of reasons, not the least of which was that the Trump administration, just four months earlier, had filed a brief with a federal court in Texas, urging it to strip Americans with pre-existing conditions of their protections under the Affordable Care Act.

Yesterday, Trump’s Justice Department took the Republican crusade against “Obamacare” to a striking new level: the president and his administration would no longer be satisfied with the courts tearing down protections for Americans with pre-existing conditions; Team Trump now wants the courts to tear down the health care reform law in its entirety.

The Trump administration broadened its attack on the Affordable Care Act on Monday, telling a federal appeals court that it now believed the entire law should be invalidated.

The administration had previously said that the law’s protections for people with pre-existing conditions should be struck down, but that the rest of the law, including the expansion of Medicaid, should survive.

If the appeals court accepts the Trump administration’s new arguments, millions of people could lose health insurance, including those who gained coverage through the expansion of Medicaid and those who have private coverage subsidized by the federal government.

Not to put too fine a point on this, but the Trump administration’s position, as of yesterday, is that the courts should do what Congress did not: destroy the existing health care system, taking health security from tens of millions of Americans.

All of this stems from a ridiculous court ruling issued shortly before Christmas, when a Republican jurist endorsed a deeply strange Republican lawsuit. Even some conservative legal experts, who’ve been deeply critical of the ACA, criticized the decision, with one calling it “embarrassingly bad.”

In that case, 20 far-right state attorneys general asked the court to invalidate protections for Americans with pre-existing conditions, but the judge decided to go further, rejecting the entire Affordable Care Act. The law remains intact, however, at least for now, as the appeals process moves forward.

Yesterday, Trump’s Justice Department endorsed the lower court’s ruling and asked an appeals court to endorse it.

If Trump’s position prevails, literally every benefit from the nine-year-old reform law would evaporate, and families that have come to rely on the ACA would be left with nothing.

The war against “Obamacare” has reached a new stage.

Postscript: The timing of the Trump administration’s new position was notable in large part because it came the same day as House Democrats unveiled a plan to make some incremental improvements to the existing ACA. It created quite a pair of bookends: on the same day Democratic lawmakers unveiled a proposal to expand Americans’ health security, the Republican administration took a new step to end health security for millions of American families.