Andy Slavitt

Opinion columnist

President Donald Trump apparently hasn't had enough of the health care fueled butt-kicking handed to him and his party in the midterm elections. He heralded as "Great news for America!" a ruling from a Texas judge Friday that found the entire Affordable Care Act unconstitutional. Once again, Trump and Republicans have put taking away health care at the top of the agenda, this time for the 2020 presidential election.

Let's look at what this ruling would do if it were allowed to stand. What part would be great for America, as Trump claims?

Seventeen million people would lose their coverage in a single year. Not great.

Americans with pre-existing conditions — as many as 130 million — would lose the law's protections against unaffordable insurance policies and denials of coverage. This was not a small issue in the midterms. Also not great.

The expansion of Medicaid to more low-income families would end — causing real damage to millions of people, states and community hospitals that have made so much progress since it passed. Again, not great.

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Insurance companies would no longer have to offer coverage of kids up to age 26 on their parents' plan. Annual and lifetime limits would be back. Women and people over 50 would see higher prices and discrimination would be legal again. Is that great?

The closing of the Medicare prescription drug coverage gap (the "donut hole"), which has saved seniors thousands of dollars on their medications, would be gone.Is it great, yet?

Which part, Mr. Trump, is the great part, other than the opportunity for you to send out a nasty tweet and put people in agony?

Republicans in Congress, starting with Senate Majority Leader Mitch McConnell, have defended this lawsuit even as Republican candidates all over the country "pledged" their support for pre-existing condition protections during the midterms. Now that those campaign ads are over, we get to see them wink at the camera.

Make no mistake, with few exceptions, this is a ruling supported by the near entirety of the Republican Party — from Trump to congressional leaders to governors and state attorneys general. It's their dream come true.

Even conservatives say ACA ruling won't stand

The part of "repeal and replace" Republicans never liked was the "replace" part. The Republican health care position is to let insurance companies charge as much as they like and cover as little as they like.

They voted to kill or sabotage the ACA over 70 times with no replacement, and their preferred approach after Trump was elected was "repeal and delay." Now a judge in Texas would deliver all that Republicans couldn’t deliver in Congress, and more.

Politically, Republicans may try to use the ruling to try to get Democrats to compromise their principles and bait them into supporting some weak cover story of a health care bill. Democrats, and likely House Speaker Nancy Pelosi, won't bite. To most Americans, the ACA doesn't go far enough and Democrats know that.

Conservative legal scholar Jonathan Adler, no ACA supporter, calls the Texas judge’s ruling "weak," "insane" and so full of legal holes that appellate court judges and even the more conservative Supreme Court wouldn't support it.

Fortunately, one judge in Texas doesn't get to undo the Affordable Care Act. The case will make its way through the courts and has the potential to end up in Chief Justice John Roberts' Supreme Court in 2020 during the throes of an election year.

By pushing this through the courts, Trump has now ensured that this deeply unpopular GOP position to strip away pre-existing condition coverage will stay in the news. These reminders will be loud enough to break through all the other noise and turn the 2020 election into yet another referendum on health care, even on top of the growing list of serious crimes in which the president is implicated.

GOP is inflicting nonstop terror on Americans

Even if this case goes nowhere, as most observers expect, it causes damage. Trump and the Republicans are inflicting a kind of nonstop terror on the American public. Year after year, millions of people wonder whether eventually, by hook or by crook, Republicans will succeed in overturning the ACA and the coverage and protections they rely on.

Sleepless nights are supposed to be reserved for crying babies, not wondering if your own government will pull the rug out from under you. There are many pundits and experts reacting to this news, but it's the real people in communities across the country who now face more years of uncertainty.

Alison Chandra, whose son Ethan was born with a rare genetic disorder, spoke for many in an interview on CNN. She sees this case as "the continuation of a nightmare." She lamented that the president, in his tweet, "celebrated the fact that so many of the most vulnerable potentially will not be able to access life-saving care."

It's what Allison said next, as she held 4-year old Ethan on her lap, calmly looked at the camera and considered Trump celebrating her uncertainty, that should haunt Trump and his party: "And I will never forget that." Trump is making sure of it.

Andy Slavitt, a member of USA TODAY's Board of Contributors, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt