The Justice Department advocated striking all of the ACA, not just select elements like protections for patients with pre-existing conditions. | AP Photo/J. David Ake, File Health care In shift, Trump administration backs judge’s ruling that would kill Obamacare

The Trump administration on Monday said it supports a federal judge's ruling that the entire Affordable Care Act should be thrown out, signaling a shift in the Justice Department's position and alarming Democrats who vowed to oppose the move.

"The Department of Justice has determined that the district court's judgment should be affirmed," three Justice Department lawyers wrote to the 5th Circuit Court of Appeals, which is now considering the case. "[T]he United States is not urging that any portion of the district court's judgment be reversed."


Regardless of the outcome, legal experts anticipate that the 5th Circuit's ruling will be appealed to the Supreme Court. If the courts ultimately strike down Obamacare — over the objections of a group of Democrat-led states, which have spent more than a year defending the health law in court — the consequences could be substantial for patients, health care organizations and other groups that have adapted to the nine-year-old law.

More than 20 million Americans are covered through the ACA's Medicaid expansion and its insurance exchanges. The sweeping law — the object of repeated legal challenges since its 2010 passage — has transformed the nation's health system, creating new patient protections and reshaping payments for doctors and hospitals.

Some of the Trump administration's proposed drug price reforms depend on provisions contained in the ACA. Senior Trump health officials haven't detailed how they would respond if all of Obamacare is struck down.

The GOP-led states that initially brought the lawsuit, Texas v. United States, had called for the entire law to be invalidated because Congress eliminated its individual insurance mandate penalty — an argument that swayed U.S. District Court Judge Reed O’Connor, a George W. Bush appointee.

The Trump administration had previously argued that only elements of the ACA, like its protections for patients with pre-existing conditions, should be struck down but that other parts of the law could stand.

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House Democrats — who had separately planned to introduce legislation on Tuesday that would fortify Obamacare — denounced the Trump administration's new legal position as "unconscionable."

"Millions of Americans will lose their health care immediately if this decision is upheld," Rep. Frank Pallone (D-N.J.), chairman of the House Energy and Commerce Committee, said in a statement. "We will do everything we can to defeat this attempt to rip away Americans’ health care."

Justice Department spokesperson Kerri Kupec said the department "has determined that the district court’s comprehensive opinion came to the correct conclusion and will support it on appeal.”

Pressed by Senate Democrats at his January confirmation hearing, Attorney General Bill Barr pledged to reconsider the Justice Department's stance on the lawsuit. But legal experts hadn't expected Barr to stake out a more aggressive position than his predecessor Jeff Sessions, who told career Justice Department lawyers to drop their defense of the law — a near-unprecedented decision that led three lawyers to remove their names from the government’s brief and prompted the senior attorney, Joel McElvain, to resign.

"Barr inherited an indefensible legal position. But instead of backing down, he's embraced a downright crazy one" said Nick Bagley, a University of Michigan law professor who's criticized O'Connor's ruling.

A group of Democratic-led states led by California is challenging the Texas ruling, arguing that the federal health care law can remain in place even without a tax penalty for Americans who forego health coverage.

