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June Recess

Intro: On June 25th Trump’s DOJ and Republican States Defend Their Support of the Texas Lawsuit to Overturn the ACA

This packet has resources to support your communications to constituents and the media on the disastrous implications on the Trump Texas lawsuit to repeal the Affordable Care Act, particularly in the middle of the coronavirus crisis.

On June 25th the Trump Administration Files Its Brief at the Supreme Court To Overturn The Affordable Care Act 

On June 25th, the Trump administration and Republican-led states will file briefs in support of their lawsuit to overturn the Affordable Care Act (ACA) and rip health care from 20 million Americans, raise health care costs and gut protections for 135 million Americans with pre-existing conditions as the nation is still reeling from the coronavirus pandemic. 

This may be one of the last opportunities to highlight the devastating impact of the Texas lawsuit ahead of oral arguments, which are expected before the November election. Health care, particularly during the pandemic, remains the number one issue for Americans and the Texas lawsuit is the most powerful example of the Republican war on America’s health care. 

Taking Action

The best way to highlight the threat is by explaining just how devastating this lawsuit is in the middle of a pandemic — ripping health care away from 20 million Americans would be when tens of millions have already lost their employer-based health coverage and how outrageous ripping protections away from millions of Americans with pre-existing conditions would be as this pandemic rages, especially when everyone who contracts coronavirus could later be denied coverage as a result.

Before the ACA, common conditions like asthma, diabetes, and cancer were grounds for insurance companies charging patients more or denying them coverage altogether. This also included HIV, a virus that has been the source of one of the most serious global health crises before the coronavirus pandemic. Without ACA protections, it is likely that everyone who contracts the coronavirus could similarly be deemed as having a pre-existing condition and be at the mercy of their insurance companies who could refuse to pay for needed care. 

Starting on Monday, Protect Our Care launched 12 days of action to sound the alarm on this lawsuit and make clear what’s at stake in the case by highlighting specific aspects of the ACA that would be ripped away if the Trump administration and Republicans are successful in overturning the law. 

As always, it’s critical to lift up voices of those who have benefited from the law and those who will suffer if it is overturned. This includes the 135 million Americans with pre-existing conditions whose protections would be ripped away if the law is overturned. Or someone who has tested positive for coronavirus and could now be considered to have a pre-existing condition by insurance companies. Or how anyone who has received coverage under Medicaid expansion would lose that coverage if the law is overturned. These stories are essential in making the reality of this situation clear to the press and the public that taking away this law in the midst of the pandemic would be cataclysmic for Americans’ health care.

If you’d like to work with Protect Our Care in your district, contact Anne Shoup at [email protected]

How We Got Here

Republicans in Congress have tried and failed dozens of times to repeal or weaken the Affordable Care Act and since day one of his presidency, Donald Trump has done everything in his power to sabotage and undermine the law. When he failed in Congress to overturn it, the president and Republican attorneys general turned to the courts. That case, California v. Texas, is now before the Supreme Court. In May, Democratic attorneys general and the House of Representatives submitted their briefs urging the court to reject the disastrous Trump-Republican lawsuit and protect the health care of millions of Americans. Now, Republican states and the Trump administration are submitting their briefs in response. The case will be argued before the Supreme Court in its next term, quite possibly before the election in November. 

The submission of these briefs from the Trump administration on June 25th will put this politically-motivated lawsuit on full display for the American people in front of the highest court. And as this case comes back into focus, it’s especially important that Americans understand just what’s at stake if the law is overturned, particularly in the midst of a global pandemic.

The Trump Lawsuit Will Make the Coronavirus Crisis Far Worse

Simply put, there has never been a more important time to protect and expand Americans’ health care, and never been a worse time to rip it away. No action would be more damaging to Americans’ health and safety than if the Trump administration achieves its desired goal of overturning the ACA in its entirety during this crisis. When the court hears this case, there will likely be no vaccine and no viable treatment for the virus. When millions of Americans have already lost health insurance due to the pandemic, it’s absurd that President Trump is arguing in court that 20 million more Americans should lose their health care. And when millions of Americans with the coronavirus join the 135 million Americans with a pre-existing condition, President Trump will also be arguing in court to allow insurance companies to deny them coverage or charge them more. 

As the Trump administration and state Republicans present their case for doing just that, Democrats will soon put forth legislation to expand coverage and lower costs for Americans during this unprecedented health care crisis. The contrast of agendas could not be more stark. 

At a time when Democrats are taking aggressive action to protect and expand health care for all Americans, like fully expanding Medicaid, opening a special enrollment period for the uninsured, and increasing financial assistance for people purchasing insurance, the Trump administration is instead arguing in court that the entire law should be overturned and programs like Medicaid expansion — which has covered millions more Americans — should be eliminated. If the Trump administration is serious about protecting Americans they would drop this lawsuit, yet sadly they have demonstrated that their desire to destroy the law trumps the health and safety of our nation.

Supreme Court Will Decide Fate of Trump-Texas Lawsuit in Upcoming Term

In March, the Supreme Court granted cert in the Trump-Republican lawsuit to overturn the Affordable Care Act. This means arguments will likely be held next fall–just as voters prepare to cast their 2020 ballots. If President Trump and his allies are successful, 135 million Americans with pre-existing conditions will lose protections and 20 million Americans will lose coverage. Every serious legal scholar agrees that this Trump-Republican lawsuit is entirely without merit. Every Republican who claims to care about health care should tell the president to drop this lawsuit.

April 2020 POC Poll Found That Less Than 30 Percent Of Voters Support Trump’s Lawsuit To Overturn The ACA. While more than half of voters oppose Trump’s lawsuit to strike down the ACA, only 29%–and just 44% of Republicans–support the lawsuit.


Fact Sheet On Trump Lawsuit To Overturn ACA

President Trump is trying to rip apart our health care by going to court to eliminate the Affordable Care Act in its entirety. If the Trump lawsuit is successful, it will strip coverage from millions of Americans, raise premiums, end protections for people with pre-existing conditions, put insurance companies back in charge, and force seniors to pay more for prescription drugs. The result will be to — as the Trump Administration itself admitted in Court — unleash “chaos” in our entire health care system. 

If the Affordable Care Act is struck down:

  • GONE: Protections for 135 million Americans with pre-existing conditions. The uninsured rate will increase by 65 percent. 
  • GONE: Medicaid expansion, which covers 17 million people. 
  • GONE: Nearly 12 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.
  • GONE: 2.3 million adult children will no longer be able to stay on their parents’ insurance. 
  • GONE: Insurance companies will be able to charge women 50 percent more than men.
  • GONE: Financial assistance that helps 9 million people purchase health care in the marketplace.
  • GONE: Key support for rural hospitals. As Americans lose coverage, already struggling hospitals will be hit even harder as their costs increase.
  • GONE: Ban on insurance companies having lifetime caps on coverage.
  • GONE: Requirements that insurance companies cover prescription drugs and maternity care.

Thanks To The Republican Lawsuit, 20 Million People Could Lose Their Coverage

  • According to the Urban Institute, 19.9 million people could lose coverage by repealing the Affordable Care Act, meaning the number of uninsured Americans would increase from 30.4 million to 50.3 million, representing a leading to a 65 percent increase in the uninsured rate. As the uninsured rate swells, so will the amount of uncompensated care, which Urban predicts will grow by at least 82 percent.
  • States would lose important federal health care funding — an estimated reduction of $135 billion in the first year. The Urban Institute estimates that a full repeal of the ACA would reduce federal spending on Medicaid/CHIP care and Marketplace subsidies by $135 billion, or 34.6 percent in the first year.
  • Millions of children could lose their coverage. Almost three million children nationwide gained coverage thanks to the ACA. If the law is overturned, many of these children will lose their insurance.
  • The percentage of people gaining health insurance under the ACA was higher for Latinos than for any other racial or ethnic group in the country. According to a study from Families USA, 5.4 million Latinos would lose coverage if the lawsuit succeeds in overturning the ACA. 

Republicans Want To Put Insurance Companies Back In Charge, Ending Protections For The 135 Million People With A Pre-Existing Condition

  • According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. This includes:
    • 44 million people who have high blood pressure
    • 45 million people who have behavioral health disorders
    • 44 million people who have high cholesterol
    • 34 million people who have asthma and chronic lung disease
    • 34 million people who have osteoarthritis and other joint disorders

Republicans Want To Give Insurance Companies The Power To Deny Or Drop Coverage Because Of A Pre-Existing Condition

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. Now insurance companies have license to do this again.

  • A 2010 congressional report found that the top four health insurance companies denied coverage to one in seven consumers on the individual market over a three year period. 
  • A 2009 congressional report found that the of the largest insurance companies had retroactively canceled coverage for 20,000 people over the previous five year period
  • An analysis by Avalere finds that “102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs” if the Trump-GOP lawsuit is successful.

Republicans Want To Give Insurance Companies The Power To Charge You More, While Their Profits Soar

  • 138 Million Americans Could Once Again Have To Pay For Preventive Care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers. This includes nearly 138 million Americans, most of whom have employer coverage.
  • Premium Surcharges Can Once Again Be In The Six Figures. Thanks to the Republican lawsuit, insurance companies can charge people more because of a pre-existing condition. The House-passed repeal bill had a similar provision, and an analysis by the Center for American Progress found that insurers could charge up to $4,270 more for asthma, $17,060 more for pregnancy, $26,180 more for rheumatoid arthritis and $140,510 more for metastatic cancer.
  • Women Can Be Charged More Than Men For The Same Coverage. Prior to the ACA, women, for example, were often charged premiums on the nongroup market of up to 50 percent higher than they charged men for the same coverage. 
  • People Over The Age of 50 Can Face A $4,000 “Age Tax.” Thanks to the Republican lawsuit, insurance companies can charge people over 50 more than younger people. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the Republican repeal bills, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to the AARP.
  • Nine Million People In The Marketplaces Will Pay More For Coverage. Thanks to the Republican lawsuit, consumers no longer have access to tax credits that help them pay their marketplace premiums, meaning roughly nine million people who receive these tax credits to pay for coverage will have to pay more.
  • Seniors Will Have To Pay More For Prescription Drugs. Thanks to the Republican lawsuit, seniors will have to pay more for prescription drugs because the Medicare “donut” hole got reopened. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.

Republicans Want To Give Insurance Companies The Power To Limit The Care You Get, Even If You Have Insurance Through Your Employer

  • Reinstate Lifetime and Annual Limits On 109 Million Privately Insured Americans. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage for those insured through their employer or on the individual market.
  • Insurance Companies Do Not Have to Provide the Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.
  • Large Employers Could Choose to Follow Any State’s Guidance, Enabling Them Put Annual and Lifetime Limits on Their Employees’ Health Care. Without the ACA’s definition of essential health benefits (EHB) in even some states, states could eliminate them altogether. Large employers could choose to apply any state’s standard, making state regulations essentially meaningless. Because the prohibition on annual and lifetime limits only applies to essential health benefits, this change would allow employers to reinstate annual and lifetime limits on their employees’ coverage.

Republicans Want To End Medicaid Expansion

  • Seventeen Million People Enrolled Through Medicaid Expansion Could Lose Coverage.
  • Access To Treatment Would Be In Jeopardy For 800,000 People With Opioid Use Disorder. Roughly four in ten, or 800,000 people with an opioid use disorder are enrolled in Medicaid. Many became eligible through Medicaid expansion.
  • Key Support For Rural Hospitals Would Disappear, leaving hospitals with $9.6 billion more in uncompensated care. 

Overturning the ACA Would Devastate Black Americans 

Racial disparities in health care have meant that Black Americans are disportionately being infected, hospitalized and dying from coronavirus. Black Americans are far more likely to be uninsured and face additional barriers to accessing health care, which has left them at much higher risk for developing serious complications if they contract the virus. 

There is overwhelming evidence that the Affordable Care Act (ACA) has made a historic contribution to improving health care for communities of color, particularly for Black Americans. In addition to increasing coverage and improving health outcomes, the law has helped narrow racial disparities in maternal health, cancer care, and more. At a time when millions of people are facing the possibility of coronavirus and devastating health care bills, strengthening coverage under the ACA is more important than ever. As Trump doubles down on his support for the lawsuit that would cause the Black uninsurance rate to spike to 20 percent, House Democrats are putting forth legislation that would expand ACA coverage to help individuals who get sick and to help communities slow the spread of the virus by helping detecting cases sooner. Building on the success of the ACA, Speaker Pelosi has announced that the House will vote on legislation this month to expand coverage and lower health care costs. This legislation will reduce health care disparities and help Black Americans get the care they need during this unprecedented health care crisis. Based on previous bills, it is expected that the legislation would help expand Medicaid, ban short-term junk plans, and lower health insurance premiums. 


The ACA helped reduce longstanding racial disparities in coverage rates, improving health care access for communities of color across the board. 

The ACA helped lower the uninsured rate for African Americans by more than one third. Before the passage of the ACA, more than 16 percent of the nearly 50 million Americans lacking health insurance were African Americans. According to the Center on Budget and Policy Priorities, the ACA helped lower the uninsured rate for nonelderly African Americans by more than one third between 2013 and 2016 from 18.9 percent to 11.7 percent. 


Further Medicaid Expansion Would Help Millions Of African Americans Gain Coverage

After the implementation of the ACA, gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. Black Americans make up 13.4 percent of the U.S. population but 20 percent of Medicaid enrollees. Today, a Black person living in an expansion state is more likely to be insured than a white person residing in a state that rejected Medicaid expansion. 

Black Americans Disproportionately Reside In The South In States That Refused To Expand Medicaid. “Many black Americans in the South live in states that did not expand insurance after the passage of Obamacare at the start of the last decade. The region coincides with the ‘Stroke Belt’ across the southeastern US, where there is a 50% higher risk of a deadly stroke, compared to the rest of the country, and an even higher risk for black people living there. The observation is linked in studies to higher rates of diabetes, heart disease, and smoking, as well as less access to health care in general.” [Buzzfeed News, 4/10/20

Ending Junk Plans That Don’t Cover Pre-Existing Conditions Is Especially Important For Black Families

Black Americans are more likely to have pre-existing conditions that not only put them at heightened risk from coronavirus but also for being denied coverage under Trump-backed short-term plans. Reports have already shown that people covered by these plans have been left with thousands of dollars in medical bills for seeking treatment for coronavirus symptoms. One analysis found widespread misleading marketing of short-term plans during the pandemic. 

Brookings Institute Survey Found Widespread Misleading Marketing Of Short Term Plans During Pandemic. “On March 18, 19, and 20, we conducted a series of phone conversations with health insurance agents, brokers, and other salespeople to investigate marketing practices associated with COVID-19. Posing as a 36-year-old woman seeking coverage because of concerns about COVID-19…we were offered a variety of short-term or other non-compliant plans from nine different brokers. In these conversations, we discussed plan coverage and asked questions about how the coverage would apply if the enrollee were to need care related to COVID-19. Salespeople were quick to reassure us that COVID-19 related costs would be broadly covered, despite plan documents or other statements indicating that the coverage would not be nearly as robust as promised. In the conversations, we heard misleading – and sometimes false – information about how COVID-19 related testing and treatment would be covered by the plan and the circumstances under which it would be a pre-existing condition.” [Brookings, 3/24/20

Black Americans Have Higher Rates Of Chronic Illnesses. “From automobile and refinery pollution to lead-contaminated water and food deserts, structural and environmental racism has contributed to higher rates of serious chronic health conditions in communities of color. Today, approximately 18 percent of Black Americans have been diagnosed with asthma. As many as 15 percent of Black Americans have been diagnosed with diabetes. People of color also experience higher rates of obesity, HIV/AIDS, chronic obstructive pulmonary disease, and other chronic conditions. On a good day, these conditions make life more complicated and difficult—but during a global pandemic, they are life-threatening.” [Center For American Progress, 3/27/20]

Lowering the Cost of Coverage by Increasing Financial Assistance Through the ACA Will Result in Far More Black Families Getting Coverage

Expanding the number of middle class families who can get financial support and increasing the amount of financial assistance available will mean millions of Americans would see their premiums reduced. This is especially important for Black families, who, even before the coronavirus crisis, saw higher unemployment rates and lower median wealth than white people, and now are suffering even more from the economic fallout of the pandemic. 

The Median Income Among African Americans Is 41 Percent Lower Than For White Americans. “A survey by the Federal Reserve last year found that even in good times, African Americans are less able to pay their monthly bills than whites or Latinos. That’s hardly surprising, since median income among African Americans is 41% lower than that of non-Hispanic whites.” [NPR, 6/1/20


Trump Is Backing A Lawsuit That Would Overturn The ACA, Which Would Cause The Uninsured Rate Among Black Americans To Spike To 20 Percent. “Everything would go: protections for preexisting conditions, subsidies that help people purchase insurance, the Medicaid expansion…States that expanded Medicaid would get the worst of it: Urban projected their uninsured rates would nearly double if the law were overturned. The uninsured rate for black Americans would increase from 11 percent today to 20 percent without Obamacare; there would also be a dramatic spike in uninsurance among Hispanics.” [Vox, 3/2/20

Trump Has Spent His Presidency Sabotaging The ACA & Medicaid, Leaving More African Americans Without Coverage. “Insurance gains made by blacks and Hispanics have stalled, and even eroded, since 2016 — much as they have for the overall population. Black adults have seen their uninsured rate tick up by 0.7 percentage points since 2016, while white adults have seen a half-percentage-point increase. This has largely halted the improvement in coverage disparities. Hispanic adults continue to report significantly higher uninsured rates than either white or black adults.” [Commonwealth Fund, 1/16/20

Trump Is Refusing To Open A Special Enrollment Period, Which Could Help African Americans Get The Health Care They Need. “If Trump had chosen instead to reopen the website — as 11 largely blue states that control their own markets have already done — people without insurance could buy more comprehensive policies that not only would cover coronavirus treatments but any follow-up treatment, mental-health care, and future check-ups.” [Politico, 4/3/20

Top Ways the ACA Helps Fight Coronavirus 

The Affordable Care Act is a critical tool to help the U.S. coronavirus response. If Trump is successful in overturning the law in court, we will lose key protections: 

  • Coverage for 20+ Million People. Because of the ACA, more than 20 million Americans gained health coverage. People with insurance are much more likely to see a doctor when they are sick and to get the treatment they need. 
  • Protections For 135 Million People With Pre-Existing Conditions. Thanks to the ACA, insurers can no longer deny or drop coverage because of a pre-existing condition. Anyone who contracts the coronavirus will not be subject to future discrimination from their insurance companies. 
  • Free Preventative Care. Because of the ACA, health plans must cover designated preventive services — including screening tests without cost-sharing. 
  • Comprehensive Coverage. Because of the ACA, insurers have to cover what are known as “essential health benefits,” such as prescription drugs and hospitalization. Coronavirus testing and treatment are essential health benefits and must be covered by all ACA-compliant plans.
  • Access To Critical Vaccinations Without Cost Sharing. The Affordable Care Act will almost certainly cover the coronavirus vaccine without cost-sharing, because it requires plans to cover all vaccinations recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). 
  • Increased CDC Funding. The Affordable Care Act established the CDC Prevention and Public Health Fund, which helps states prepare for disease outbreaks. The Washington Post reported that this fund “provides almost $1 billion annually to CDC, now about 12 percent of CDC’s budget. It includes prevention of bioterrorism and disease outbreaks, as well as money to provide immunizations and heart-disease screenings.”
  • Medicaid Expansion. Because of the ACA, states can get additional federal money to expand Medicaid to vulnerable populations. More than 17 million Americans now have coverage through Medicaid expansion. Importantly, Medicaid’s funding structure allows funds to increase in response to a public health emergency like coronavirus. 
  • Key Support For Rural Hospitals. The ACA led to a $12 billion reduction in uncompensated care costs. Between 2013 and 2015, hospitals’ uncompensated care costs decreased by $12 billion, or roughly 30 percent. As hospitals prepare for an influx in patients, it is critical that they are paid for the treatment they provide. 

State-By-State Facts Sheets