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Same as it ever was, same as it ever was...


After spending most of last year trying and failing to kill the Affordable Care Act in Congress, plus undercutting the law in a hundred dumb ways, Donald Trump has finally hit on a strategy that just might rid Americans of the horrors of health insurance and return us to the good old days when insurers could deny you any health coverage at all because you got sick one time. In a letter sent to Congress Thursday night, Attorney General Jeff Sessions (vomit!) announced the Justice Department will not defend a lawsuit against Obamacare by Republican states, agreeing with their dubious argument that the law is now unconstitutional. The letter specifies the decision was made "with the approval of the President of the United States," and didn't even put Trump's title in quotation marks, a clear violation of Wonkette prose style.

Here's the crappy-ass argument Sessions finds persuasive: In its 2012 decision upholding Obamacare, the Roberts court held that since the law included a tax on people who didn't buy health insurance, the individual mandate was perfectly cromulent constitutionally. Oh ho! say the red state Republicans in the latest lawsuit, led by Texas, now that the Big Fat Tax Cuts for Rich Fuckwads Act of 2017 killed off the individual mandate -- or at least reduced the tax penalty for people without insurance to zero -- then the constitutional justification for the individual mandate has been voided. And since the individual mandate is central to the ACA, the entire law has to be found null and void, do not pass Go, do not get those life-saving medications. Go Directly to the Gutter to Die, HOORAY!

And to think all Trump had to do was tell Sessions to not do anything. Not doing anything is one of Donald Trump's favorite things! Maybe Sessions has finally won Trump's love! (He has not.)

Now, in his letter, Sessions argues that not all parts of the ACA have to go -- just the most popular provision, which requires insurers to issue policies to all buyers, without premium penalties for preexisting conditions and limiting how much premiums can be ratcheted up for older Americans who don't yet qualify for Medicare. This is important: a return to denials and higher premiums for preexisting conditions would affect ALL insurance, not just plans sold in the individual market.

Still, Sessions suggests he'd be willing to defend other parts of the ACA, like the provision allowing parents to buy insurance for their dependents up to the age of 26 -- but only if the parents can get coverage themselves, and the kids have never been treated for anything, ever. Take that, Jimmy Kimmel's communist baby! The Texas lawsuit argues that Obamacare's Medicaid expansion would also be automatically rolled back, while Sessions's narower reading would leave it in place -- to be killed by Congress, of course.

Oh, and did we mention Trump's new policy comes just as health insurers are preparing to set their premiums for 2019? Convenient timing, that.

Before you lose hope -- and Jesus H. Christ on a rocket sled to Gethsemane, this IS a terrifying development, because as we say, it would affect all health insurance -- keep in mind that Trump's decision not to defend the law doesn't automatically kill Obamacare. The Texas suit has to make its way through the courts, and a group of blue states has already won standing to defend the law against the red-state lawsuit. So even though the judge who's currently hearing the Texas case has previously ruled against other portions of the ACA, the appeals process will not end there even with the DOJ refusing to defend a legitimate law.

As University of Michigan law professor Nicholas Bagley points out in an excellent Twitter thread the Texas lawsuit is weak sad poop, BUT it also sets a dangerous legal precedent -- like so many goddamned things the Trump administration is out to do:

How shitty is the Texas case? Bagley and several others point out that three career DOJ attorneys asked to have themselves removed from the case before Sessions made his announcement, which generally means they thought the case was so weak they didn't want their names anywhere near it.

For a discussion of the larger danger here, see Bagley's blog post from the initial filing of the Texas lawsuit. What Trump is doing here is saying his administration will only defend laws he personally approves of, not the laws that Congress has passed, which ought to scare us far beyond just the issue of healthcare. Sessions's bullshit claim that the ACA was rendered unconstitutional by a tax cut bill isn't just a slam at Obamacare, of course: it's a double punishment for the previous administration, since Obama and Eric Holder elected not to defend the Defense Of Marriage Act.

For more discussion of how the end of protections against preexisting conditions would affect EVERYONE who isn't already rich, young, and in perfect health, see this discussion by healthcare analyst Charles Gaba. For starters, keep in mind that last year, when Trump was hot to kill Obamacare altogether, estimates of the number of Americans who would die ran into the tens of thousands. But they probably weren't people you or people you know, unless of course you now have coverage for a condition that could be dropped.

For a terrific general overview of why this is bad and what you can do to fight it, see this thread by Andy Slavitt, Barack Obama's director of the Centers for Medicare and Medicaid Services, from the quaint old days when presidents and their cabinets followed laws instead of dismantling them.

And now all matters of law and legal precedent will forever be left to the whims of the executive branch forever, and over a hundred million Americans may lose or pay tons more for their health coverage, to own the libs. Don't count on any rights lasting too long, OK? Maybe spend your weekend contacting the campaign of your nearest Democrat. There's work to be done, and not a moment to be lost.

[WaPo / Vox / DOJ letter / Center for American Progress / Nicholas Bagley on Twitter / The Incidental Economist / Charles Gaba on Twitter / Andy Slavitt on Twitter]

Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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