Donald Trump
Credit: Shealah Craighead\Flickr

This is both radical and politically reckless. It’s also callous to a degree that’s hard to fathom.

The Trump administration said Thursday night that it will not defend the Affordable Care Act against the latest legal challenge to its constitutionality — a dramatic break from the executive branch’s tradition of arguing to uphold existing statutes and a land mine for health insurance changes the ACA brought about.

In a brief filed in a Texas federal court and an accompanying letter to the House and Senate leaders of both parties, the Justice Department agrees in large part with the 20 Republican-led states that brought the suit. They contend that the ACA provision requiring most Americans to carry health insurance soon will no longer be constitutional and that, as a result, consumer insurance protections under the law will not be valid, either.

The three-page letter from Attorney General Jeff Sessions begins by saying that Justice adopted its position “with the approval of the President of the United States.”

The single best thing the government has done in the last 20 years is to make it so people with pre-existing conditions can get affordable health insurance. If you’re not going to give everyone health care coverage, then you absolutely have to make it possible for people to afford treatment, and people with pre-existing conditions cannot actuarially be insured at an affordable price.

This is important from a simple fairness point of view, and it’s a basic recognition of the worth and dignity of every human being. But with an opioid crisis roiling the nation, Obamacare has been the single biggest lifesaver we have. Addiction is a pre-existing condition, and mental health is covered under the law more strongly than ever before. Without those insurance protections, treatment is going to be out of reach for the very socioeconomic classes that are being hardest hit by the epidemic. A lot of these people impacted are Trump voters, and he promised something a lot better than this. A few days ago, Reuters had a piece on this issue: Voters in opioid-plagued districts demand solutions from candidates.

Here’s an anecdotal story from that article:

Alexis Pleus thinks neither party has done enough to solve the [opioid] crisis, but says Democrats are right to push for more funding and for health insurance reform.

For her, the issue is personal. Her son, a restaurant chef, cycled in and out of jail and rehab before dying of an overdose in 2014. The last time he tried to get clean, Pleus said, he called her in tears to say his health insurance wouldn’t pay for a full course of treatment, and he would be turned out after 14 days.

“The system without a doubt failed him. He wasn’t refusing help, he was begging for help,” Pleus said.

That’s the situation people are facing with the protections of Obamacare. Voters are already pissed off that the government is not doing enough, but this move by the Trump administration is going to set people’s hair on fire.

It’s really, really, really bad politics for the Republicans, and I can’t say I am all comforted by that because we’re talking about people’s lives. And we’re talking about the lives of everyone with a preexisting condition, not just people with histories of addiction. We’re also talking about access to affordable health care for healthy people. Trump and the Republicans were probably at their lowest point in the polls when they were trying last year to toss more than 20 million people off their health care. Doing it this way isn’t going to be more popular.

Martin Longman

Martin Longman is the web editor for the Washington Monthly. See all his writing at