For proponents of the Affordable Care Act, the last couple of months have been quite encouraging, at least as far as the substance of health care is concerned. Totals from the recent open-enrollment period, for example, were solid and in line with expectations, while the latest industry data pointed to stable health care markets, Republican sabotage efforts notwithstanding.
It was against this backdrop that Utah's Medicaid expansion program got underway on Jan. 1, while policymakers in Kansas reached a bipartisan compromise to bring Medicaid expansion to the Sunflower State. Others may soon follow: Phil Cox, a former head of the Republican Governors Association and a well-known figure in D.C. circles, was quoted saying two weeks ago, "The battle has been fought and lost on Medicaid expansion."
There is, however, just one dark cloud hanging over the ACA's head. A Republican lawsuit, backed by the Trump administration, is trying to destroy "Obamacare" in its entirety, and a Texas judge has already ruled in the GOP's favor. The 5th Circuit, in a move that appeared awfully political, recently left the future of the nation's health care system in limbo, almost certainly until after the election.
The legal process may, however, move more quickly. The ACA's proponents asked the U.S. Supreme Court to take up the case, and a week ago today, the justices directed the Trump administration and Republican state officials behind the lawsuit to respond. As NBC News' Pete Williams explained, "Such a highly abbreviated timeline – the rules normally allow a month for filing a response – gives the court the option to take up the case during its current term, which would mean a ruling on a contentious issue this spring, just as the presidential campaign heats up."
On Friday, the administration filed a brief, effectively telling the high court to cool its heels. The Washington Post reported:
The Trump administration and a coalition of conservative states that have been challenging the Affordable Care Act said Friday that there is no reason for the Supreme Court to rush a ruling on the issue this term. [...]President Trump's solicitor general, Noel Francisco, replied that the [5th Circuit's] decision simply preserved the status quo until a lower court looked more closely at which parts of the law should survive. It would be premature to intervene now, he said.
The full filing is online here (pdf).
To put it mildly, the Trump administration's argument is a tough sell, at least as it relates to the ACA itself. On the one hand, the lawsuit argues that the law's individual mandate, which Republicans gutted in late 2017, was so integral to the ACA that the nation's health care system can't function effectively without it, so "Obamacare" should cease to be. On the other hand, the Trump administration is also arguing that the mandate-less ACA is working fine right now, so there's no reason for the justices to act with any haste.
Both points cannot be true.
In case this isn't obvious, political considerations appear to be at the heart of the developments. It's likely that Trump and his team realize that if the Supreme Court takes up the case in the short term, there's a very real possibility that the White House and Republicans would either (a) lose a humiliating health care case in an election year; or (b) convince five conservative justices to take health care benefits away from tens of millions of Americans in an election year.
Or put another way, this isn't a great issue for the president or his party, which helps explain why they're so eager to convince the Supreme Court to push the whole issue off for a long while.
It also helps explain why Trump is peddling truly outrageous nonsense on the issue, including a tweet this morning in which the president claimed, "I was the person who saved Pre-Existing Conditions in your Healthcare." He added, "I will always protect your Pre-Existing Conditions, the Dems will not!"
It's as brazen a lie as Trump has ever told -- and to know anything about the president is to know the competition in that category is fierce. In reality, Trump didn't "save" protections for Americans with pre-existing conditions; he fought to take those protections away through a series of far-right repeal-and-replace proposals he couldn't get through a Congress led by his own party.
Trump, of course, is also helping champion an ongoing federal lawsuit which would -- you guessed it -- strip protections for Americans with pre-existing conditions.