The Trump administration, in endorsing what is pretty much a bogus legal challenge by Texas and other conservative states to the Affordable Care Act, has exposed a truth Republicans have been desperately trying to conceal. For years, Republicans have insisted they want to keep the popular parts of Obamacare and especially the protections for people with pre-existing conditions, all while trying to sneak in changes that would effectively end those protections. Now that Trump has ripped the subterfuge away just months before an already perilous midterm election, Republicans are panicking.
"This is definitely the most popular aspect of the Obamacare legislation, and it clearly creates an opening for Democrats going into the final months of the election year," GOP strategist Ken Spain, a former communications director at the National Republican Congressional Committee, told TPM.
Poll after poll has found that protecting people with pre-existing conditions is the most emotionally potent health care argument for voters. A survey conducted by the Democratic firm Hart Research Associates for Protect Our Care this past January and shared with TPM on Friday found that the issue was one of the most effective in the healthcare debate: 63 percent of voters had "very major concerns" and another 20 percent had "somewhat major concerns" with the GOP’s efforts to repeal pre-existing condition protections. Among independents, that number rose to 73 percent with "very major concerns." In other polling, voters routinely identify healthcare as the biggest issue they care about.
Fully 27 percent of non-elderly adult Americans have a pre-existing condition—"conditions that would likely leave them uninsurable if they applied for individual market coverage under pre-ACA underwriting practices that existed in nearly all states" a Kaiser Family Foundation survey has found. That's nearly a third of the voters in states like West Virginia, Missouri and Indiana where Republicans hope to flip now-Democratic seats. Same with Tennessee and Mississippi where they need to hold seats. Despite the fact that most of the Obamacare repeal and "replace" efforts by Republicans would have resulted in an end to pre-existing condition protections by default, they've understood politically that they can't say that out loud, and in fact have argued, like Sen. Lamar Alexander (R-TN) that "There is no way the Congress is going to repeal preexisting conditions."
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And now Trump is arguing that that's exactly what the courts need to do. To make matters even worse for Republicans, even the insurance lobby—America's Health Insurance Plans—is warning that this is going to wreak havoc on the market this fall. "Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019." Those rates for 2019 are going to be announced this summer and fall, in plenty of time for voters to see what's happening.
That's all going to happen before a final legal ruling, which could take months if not years. Even if the courts rule against the Trump administration and states, the political damage will be done. Republicans are finally on the verge of being held accountable for eight solid years of attacks on our health care.