After the president and Republicans repeatedly promised to protect people with pre-existing conditions, the Trump administration on Monday evening said it supports a federal judge’s ruling that the Affordable Care Act (ACA) is unconstitutional, adding that it will seek to repeal the sweeping health care law in its entirety.

The Justice Department filed a brief letter in the conservative U.S. Court of Appeals for the Fifth Circuit telling the court that it agrees with Judge Reed O’Connor, who last year handed down an opinion purporting to strike down the entire health law. The move would eliminate health care coverage for tens of millions of people and put Medicaid expansion programs for low-income Americans in jeopardy.

The news follows months of campaigning by Republicans ahead of the 2018 midterm elections during which candidates vowed to safeguard people’s health care, specifically positioning the GOP as the party that would protect the approximately 52 million Americans living with pre-existing conditions.

“Republicans will totally protect people with Pre-Existing Conditions, Democrats will not! Vote Republican,” President Donald Trump tweeted two weeks before the election. Weeks before, he had insisted that “all Republicans support people with pre-existing conditions,” while “Democrats will destroy your Medicare.”

Republicans will totally protect people with Pre-Existing Conditions, Democrats will not! Vote Republican. — Donald J. Trump (@realDonaldTrump) October 24, 2018

The messaging was especially peculiar because the Trump administration and Republican-controlled branches of Congress don’t have the best track record when it comes to safeguarding affordable health care coverage.


The Trump administration has argued in court that protecting people with pre-existing conditions is unconstitutional. It has repeatedly proposed making huge cuts to both Medicare and Medicaid. And it has also touted junk health insurance plans, known as short-term health plans, which have glaring coverage gaps. According to the Kaiser Family Foundation, most of these plans don’t cover maternity care, mental health services, substance use disorder treatment, and outpatient prescription drugs.

Furthermore, the majority of Republicans running for re-election in competitive House races in 2018 had voted against pre-existing condition protections in the past. Of the 73 Republicans in these races, 67 voted at least once to eliminate ACA protections for people with pre-existing conditions, according to an analysis from the Center for American Progress Action Fund. The majority voted to repeal these protections repeatedly. Fifty-six Republicans voted more than once to repeal pre-existing conditions protections; 31 voted to do so more than six times; and 24 voted to repeal the protections nine times, or every chance they got. (ThinkProgress is an editorially independent publication housed at the Center for American Progress Action Fund.)

The Trump administration’s latest effort in seeking to eliminate the ACA is a return to what has long been the Republican party’s number one goal: repealing Obamacare.

In 2017, Republicans repeatedly failed to repeal Obamacare, despite holding both chambers of Congress. One proposed bill that made it out of the House would have left millions uninsured, created more expensive health plans, and massively cut Medicaid. The unsuccessful GOP alternatives often included language that guaranteed that people with pre-existing conditions could still buy some kind of insurance, but failed to include provisions to ensure that those plans remained affordable.


Last year, Senate Republicans rejected a Democratic proposal that would have blocked the Trump administration’s expansion of health plans that can deny coverage to people with pre-existing conditions. Before the vote, Sen. Tammy Baldwin (D-WI), who co-sponsored the resolution, sought to hold Republicans to their empty promises.

“I heard my colleagues on the other side of the aisle say that they are committed to protecting people with pre-existing conditions,” said Baldwin. “Now is your chance to prove it.”