Indivisible.org is a “grassroots movement of local groups to defeat the Trump agenda, elect progressive leaders and realize bold progressive policies.” Indivisible Austin created a project called Protect Our Care to share stories about people with pre-existing conditions or other health related matters and the effect the Affordable Care Act has had on their lives.

Gina in Texas wrote this when Congress was trying to repeal the Affordable Care Act:

“My father was a hardworking carpenter for many years. Sadly, in that trade benefits such as health insurance were not provided. Later in life, he developed heart problems which at the time rendered him ‘uninsurable.’ As he continued to age, his heart problems became worse and required hospitalization and surgery that cost in excess of $100,000. He was uninsured. He only lived four more months and continued to incur huge medical expenses. He was unable to work, he was not eligible for Medicaid and was too young for Medicare eligibility. Had he lived, he would have been able to obtain insurance at a rate that he could have afforded. As it was, he died leaving my mother with a HUGE medical debt. This story is not only my family’s but many others throughout our country. The new healthcare plan proposed by the Senate committee would undo so many of the great things provided by the ACA. Passage of Trumpcare would devastate millions, as the CBO has indicated. We must find a way to move forward to create a bipartisan, viable solution for our country.”

Kelly Angard is a self-employed photographer and artist who was diagnosed with stage 3 breast cancer. At the time of her diagnosis, Angard was still on her recently separated husband’s insurance but she eventually needed to obtain her own coverage. Thanks to the Affordable Care Act, insurance companies could not turn her away because of her pre-existing condition. Over a 12-month period, she underwent two rounds of chemotherapy and surgery.

With insurance under the Affordable Care Act, her treatment cost her around $16 per month. Without insurance her out of pocket costs would have been more than $5,200 per month. Angard and two other women created “Faces of the ACA,” a website dedicated to telling the stories of individuals whose lives have been saved because of the ACA. She is among the 52 million Americans with pre-existing conditions who will face denial of coverage or higher premiums if the guaranteed issue and community rating requirements under the ACA are invalidated as the Trump Administration is advocating.

The Trump Administration’s Justice Department has filed a brief in a case brought by Texas and 19 other Republican states, including Arkansas, which seek to have the entire Affordable Care Act declared unconstitutional. Texas argues that the entire basis of the ACA was dependent on the individual mandate which required individuals to buy health insurance or pay a tax penalty. The 2017 Tax Cut and Jobs Act eliminated the tax penalty as of 2019.

In a major departure from its customary role, the Justice Department failed to defend the law passed by Congress and actively took the side of Texas agreeing that the individual mandate is now unconstitutional. The Justice Department brief argued that two parts of the ACA was invalidated by the elimination of the mandate tax penalty. They said that the guaranteed issue and community rating parts of the ACA were so interconnected to the individual mandate tax penalty that those provisions cannot continue to exist without it.

According to HealthCare.gov, guaranteed issue is “a requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services.” Community rating is defined as “a rule that prevents health insurers from varying premiums within a geographic area based on age, gender, health status or other factors.” The Justice Department argument boils down to this: “Accordingly, the individual mandate ‘is essential to creating effective health insurance markets in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold.’ In short, Congress found that enforcing guaranteed issue and community rating requirements without an individual mandate would allow individuals to game the system by waiting until they were sick to purchase health insurance, thereby increasing the price of insurance for everyone else—the polar opposite of what Congress sought in enacting the ACA.”

To recap, the Trump Administration devises another scheme to hurt vulnerable people. First, they work with Tom Cotton to pass a law ending the individual mandate tax penalty. Then they use that as an excuse to terminate two of the most crucial provisions of the ACA that will cause millions of Americans to lose health insurance coverage. You have got to admit, that is a devilishly devious plan.

Led by California, 16 states and the District of Columbia, have intervened in the case in support of the ACA. This includes the Southern states of Kentucky, North Carolina and Virginia. At one point in their motion to intervene, these states explain why “preservation of the ACA is necessary to prevent grievous harm to the states and their residents”:

“Eliminating the ACA would cause immediate and long-term harm to the Intervenor States and to their residents’ health and financial security, to state healthcare systems, and to state budgets. The law is so interwoven into the U.S. health system that its elimination would even damage Medicare and other programs that pre-date the ACA. Millions of Americans would lose their insurance coverage. That loss in turn would lead to downstream costs to state-funded hospitals, which must provide emergency care regardless of a patient’s insurance status or ability to pay. Thus, the impact on the Intervenor States would be profound and widespread. Most directly, the States themselves would lose over half a trillion dollars of anticipated federal funds used to provide health care to their residents …”

An Amici Curiae (friend of the court) brief in support of the ACA was filed by the American Medical Association joined by The American Academy of Family Physicians, The American College of Physicians, The American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry. They contend that the claims made by Texas and the Justice Department that other provisions of the ACA are inseverable from the individual mandate provision are “meritless.” Their brief states:

“The severability inquiry turns on congressional intent. Here, Congress’s intent with respect to the remainder of the ACA is crystal clear. When Congress reduced the tax to $0, it did not amend, address, or otherwise touch any other ACA provision. It therefore not only intended for those ACA provisions to remain valid in the absence of the minimum essential coverage provision, but it determined that those provisions could function with a zeroed-out tax. The text of the 2017 Tax Cuts and Jobs Act is the end of the matter for severability purposes.”

The brief goes on to explain how the Plaintiff’s and the Justice Department’s requested remedies would “wreak havoc on American health care.”

“A final word must be offered about the consequences of their proposed remedies. Invalidating the guaranteed-issue and community rating provisions - or the entire ACA - would have a devastating impact on doctors, patients, and the American health care system as a whole. Put simply, the consequences of any form of inseverability would eliminate the historic gains in health insurance coverage [that] have been achieved since the implementation of the Affordable Care Act. The ACA’s ‘nationwide protections for Americans with pre-existing health conditions’ has played a ‘key role’ in allowing 3.6 million people to obtain affordable health insurance. Severing those vital insurance reforms would leave millions without much-needed insurance.

On top of that, the CBO (Congressional Budget Office) estimated that repealing ‘major provisions’ of the ACA would cause 32 million people to become uninsured and average premiums in the nongroup market to double by 2026… The CBO also projected that, by 2026, three quarters of the Nation’s population ‘would live in areas having no insurer participating in the nongroup market … because of downward pressure on enrollment and upward pressure on premiums.’ And the nonpartisan Rand Corp. has concluded that repeal would increase the federal deficit by $33.1 billion annually compared with the status quo. Plaintiffs’ and the Federal Defendants’ requested remedies would cause these same devastating results—only without the appropriate deliberation within the democratically-accountable political branches.

Amici know better than anyone that medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm.’ They respectfully submit that this court should do the same.”