Four cities filed a lawsuit against the Trump administration Thursday accusing the president and his cabinet of “waging a relentless campaign to sabotage and, ultimately, to nullify” the Affordable Care Act.

The suit — filed in a Maryland federal court by Chicago, Columbus, Cincinnati, and Baltimore — comes on the heels of the Department of Health and Human Services’ finalization Wednesday of regulations allowing people to keep short-term health insurance plans for up to three years. Under the Obama administration, short-term plans, which are cheap and provide less coverage, were limited to only three months. As healthy people leave the ACA marketplace for these cheaper plans, the sicker pool is left with increasing premiums.

The Trump administration’s move to finalize the rules are indicative of a broader strategy to quietly chip away at Obamacare until the health law ultimately “implodes,” fulfilling Trump’s promise. Over the past year and a half, the Trump administration has also finalized regulations to expand association health plans, which are not required to cover basic health benefits, and has gotten rid of the individual mandate, cut back on funds to advertise the ACA, and refused to defend the ACA in court, arguing that protections for people with pre-existing conditions are unconstitutional.

As the Republican-controlled Congress has consistently failed to repeal the ACA, the lawsuit accuses the administration of “deliberately trying to make the Act fail” on its own, citing “remarkably transparent” statements by the president that prove his intent:

“If we don’t get it done” in Congress, President Trump has said, “we are going to watch Obamacare go down the tubes, and we’ll blame the Democrats . . . [a]nd at some point, they are going to come and say, ‘You’ve got to help us.’” “[W]e are getting rid of Obamacare,” President Trump has boasted, “essentially, we have gotten rid of it,” “[i]t’s dead[,] [i]t’s essentially dead,” “there is no Obamacare, it’s dead.”

As a result of these actions, the suit reads, Americans are suffering as insurers are driven out of the ACA marketplace, premiums continue to rise, and the number of uninsured individuals increases. The 134-page filing also points out that all four cities involved in the suit have had to “spend more on uncompensated care for their residents.”


In Columbus, for instance, the suit states that, due the Trump administration’s actions, the city will have to pay more to support community health centers serving uninsured individuals and will be forced to recoup unpaid costs from greater use of its ambulatory and emergency services.

The suit asks the court to declare that the Trump administration has violated the constitution under the “take care” clause, which requires the president to ensure the ACA is faithfully executed. It also asks that the court order the administration to fully fund advertising the law, lengthen the enrollment period, and enforce the individual mandate.

This is not the first time states have sued the Trump administration over its handling of the health care law. In 2017, 18 states filed a lawsuit over the president’s attempt to block federal cost-sharing subsidies that help make health insurance affordable for low- and middle-income individuals. That case was dismissed last month. Last week, 12 states filed a lawsuit against the Trump administration’s efforts to expand association health plans.

But the suit filed by the four cities is unique, according to Abbe Gluck, a Yale University law professor.

“No scholar or court has ever said the president can use his discretion to implement a statute to purposely destroy it,” Gluck told NBC News. “If there’s ever going to be a violation of the ‘take care’ clause, this is it.”