This article is more than 1 year old

This article is more than 1 year old

The future of the Affordable Care Act is once again set to be decided by the US supreme court, amid warnings from experts that healthcare access for millions of Americans hangs in the balance.

A coalition of Democratic state attorneys has vowed to appeal a late-Friday decision by a federal judge in Texas to strike down the entire ACA, also known as Obamacare, as unconstitutional.

About 11.8 million Americans used Obamacare to enroll in health coverage this year.

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Xavier Becerra, attorney general of California, said the ruling was “an assault on 133 million Americans with pre-existing conditions, on the 20 million Americans who rely on the ACA for healthcare, and on America’s faithful progress toward affordable healthcare for all Americans”.

Becerra added Democrats would “continue to fight in court for the health and wellbeing of Americans”.

Given the looming appeal, the White House has said it expects the issue to again be decided by the supreme court, which has already upheld Obamacare twice since it was enacted in 2010.

The Trump administration welcomed the ruling by the Texas judge Reed O’Connor but added that Congress should act to preserve protections for people with pre-existing conditions, which would be swept away if Obamacare was dissolved.

The issue is politically fraught for the administration. Democrats managed to gain control of the House of Representatives in the November midterms after focusing on concerns over healthcare coverage.

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The ACA bars insurers from refusing to cover someone due to a past medical condition and sets up exchanges on which people can purchase plans. The American Medical Association has warned any repeal of the system would “destabilize health insurance coverage”.

“No one wants to go back to the days of 20% of the population uninsured and fewer patient protections, but this decision will move us in that direction,” said Barbara McAneny, president of the AMA.

In 2010, there were more than 48 million Americans without healthcare coverage, a number that fell by more than 20 million by 2016. There was a slight uptick in the uninsured population last year, however, according an analysis by the Kaiser Family Foundation.

Repealing the ACA became a defining issue for Republicans, although they were unable to do so when they held both branches of Congress following a sustained outcry over the expected harmful consequences of doing so. Donald Trump has called the ACA a “disaster” and said last year Republicans should “let Obamacare fail”.

As part of the 2017 tax bill, Republicans did manage to dismantle the individual mandate, which requires people get health coverage or face a penalty. Judge O’Connor’s 55-page ruling argues this action “sawed off the last leg” that Obamacare stood on, making it unconstitutional.

Several legal experts have been baffled by the decision. “This is insanity in print, and it will not stand up on appeal,” tweeted Nicholas Bagley, an expert in health law at the University of Michigan Law School.

The news prompted Barack Obama himself to publicly comment, writing a lengthy post on Facebook urging people to keep signing up for coverage and offering assurances that the ruling had no immediate impact.

“As this decision makes its way through the courts, which will take months, if not years, the law remains in place and will likely stay that way,” Obama wrote.

He then jabbed at Republicans in an apparent reference to the importance that healthcare – especially protecting people with pre-existing conditions – played in the recent Democratic victory in the midterm elections.

“The only way to convince them to stop trying to repeal this law, and start working to make health care better, is to keep voting, in big numbers, in every election, for people who’ll protect and improve our care,” he added.