With Obamacare under siege, Democrats fire back

Democrats are seeking to move beyond special counsel Robert S. Mueller III's report to a different action taken this week by the Justice Department: its statement supporting Texas' legal challenge to the 2010 health care law, which said the entire act should fall.

House Democrats, highlighting the differences between their positions and the administration's, unveiled draft legislation Tuesday that seeks to lower health care costs for people who get insurance coverage through the federal and state marketplaces.

The draft bill builds on Democrats' 2018 campaign message that they would protect coverage for pre-existing conditions and increase the financial assistance people receive under the law. Top Democrats on Tuesday indicated they hope to keep that focus ahead of the 2020 election, setting up a contrast with the Trump administration after it broadened its call to weaken the law by saying that all of it — not just part of it — should fall.

"This was a defining issue of the 2018 midterm elections," said House Democratic Caucus Chairman Rep. Hakeem Jeffries. "We embrace this fight, because House Democrats were given the majority in order to defend health care on behalf of everyday Americans, and that is exactly what we are doing."

The Justice Department late Monday supported a lower court ruling in the case of Texas v. Azar that declared that the entire health care law should be invalidated after the effective end of the requirement that most people have insurance coverage. That was an expansion of the administration's earlier position that only the parts of the law that ensure people with pre-existing conditions cannot be denied or charged more for insurance should fall without the so-called "individual mandate."

District Judge Reed O'Connor ruled last year that the entire law should be struck down after the 2017 tax law ended the penalty for not having insurance coverage. A group of Democratic state attorneys general led by California's Xavier Becerra appealed the ruling, and the House of Representatives is also a party to the law's defense.

The health care law has enjoyed higher popularity since President Barack Obama left office in early 2017 and Republicans unsuccessfully sought to roll back the act.

Many key Republicans have said they oppose ending the law's pre-existing condition protections.

House Minority Leader Kevin McCarthy said at a Tuesday morning press conference that he hadn't seen the filing, but said President Donald Trump has been clear he wants to overhaul the law and replace it.

"The president has always been very clear that he wanted to repeal Obamacare and put a system in that actually lowers the costs, protects individuals' pre-existing conditions and have a health care system that works," the California Republican said.

Democrats' legislative proposal

The Democratic bill mirrors earlier proposals Democrats put forward to strengthen the health care law. On Wednesday, the Energy and Commerce Health Subcommittee will mark up several smaller measures that make up part of the bill, along with other bills meant to lower prescription drug prices.

The bill would strengthen the tax credits that help marketplace enrollees within a certain income level afford their monthly premiums and would raise the income level threshold for qualifying for those subsidies, according to a fact sheet shared with Roll Call.

Ways and Means Chairman Richard E. Neal said families with an income of up to $96,000 per year would qualify for subsidies, while individuals making up to $46,000 would qualify.

The bill would also reverse actions taken by the Trump administration that Democrats say "sabotage" the health care law. The administration updated the guidance for so-called Section 1332 waivers that allow states to change certain aspects of their health insurance markets and expanded short-term plans that aren't required to comply with all of the health law's requirements, such as guaranteeing coverage for pre-existing conditions and covering 10 essential health care benefits.

The Democratic measure would also fund a reinsurance program to help cover high-cost patients, as well as programs to help people sign up for insurance coverage and for outreach, both of which the Trump administration has scaled back since taking office.

"That legislation will protect Americans with pre-existing conditions," Jeffries said. "Our legislation will expand access to health care coverage, while at the same time the Trump Justice Department files reckless legal papers to try and destroy health care for tens of millions of Americans. You can't make this up."

In a separate House Budget Committee hearing with Health and Human Services Deputy Secretary Eric Hargan on Tuesday, some Democrats criticized the administration's decision to further undercut the law. Rep. Lloyd Doggett of Texas said the administration does not have an adequate backup plan to ensure people maintain health coverage should the law fall.

"I don't see anything in your budget that would provide comparable care for the tens of millions of people that will lose out if you and the Texas attorney general are successful in destroying the Affordable Care Act," he said.

Republican response

Capitol Hill Republicans were adamant on Tuesday that they support pre-existing conditions protections, and that any alternative to the health care law would include that and other popular provisions, such as allowing children to stay on their parents' plan until they're 26.

Georgia GOP Sen. David Perdue, who is on the ballot in 2020, said after a Senate GOP lunch at the Capitol with Trump that Republicans were already working on what comes next.

"Right now, we've got a lot that we're working on in our caucus here in the Senate, and I'm optimistic that we'll have something soon," he said.

"We wasted a decade talking about insurance, when the real problem is health care delivery and health care cost," Perdue told reporters. "Individual markets don't have the same protections that people in group policies do, and this whole pre-existing conditions thing has to be resolved once and for all."

Asked about a tweet from Trump declaring that Republicans would be "the Party of Healthcare," Perdue said Trump was seeking to focus attention on policy issues.

"He's raising the level of the priority here," Perdue said.

Sen. Richard C. Shelby was asked whether the possibility of returning to the Obamacare repeal debate would be "politically dicey" for Republicans.

"Not to me," said Shelby, who represents solidly pro-Trump Alabama.

"The health care, it's going to tank. It's just a matter of when," Shelby said. "I would vote for total repeal. I have many times."

Maine Republican Susan Collins did criticize the administration's stance.

"It is highly unusual for the Department of Justice not to defend duly-enacted laws, which the Affordable Care Act certainly was," she said. "So this decision to even go more broadly in failing to defend the law is very disappointing."

Other Senate Republicans facing re-election next year said lawmakers still need to address health care affordability, although most of them stopped short of agreeing with the administration's court filing.

"What we need to do is make sure we have affordable health care," said Colorado Sen. Cory Gardner. "The Affordable Care Act itself was not, didn't fulfill the promises that they said that it would, the promise of lowering health care, people keeping their insurance."

House Energy and Commerce ranking member Greg Walden of Oregon said both sides should talk about how to ensure that coverage for pre-existing conditions remains should the law fall.

"Whatever they're going to do, they're going to do, but that leaves a vulnerability here for patients, and I want to make sure patients are covered and cared for," he said. "I haven't seen an alternative come forward that would do that from the administration."