The Affordable Care Act (ACA) has been dealt blow after blow by the Trump Administration – but this one really takes the cake!

A 20-state lawsuit filed in February argues that the individual mandate repeal renders the ACA unconstitutional. Many expected this lawsuit to be no big deal. But two weeks ago, the Justice Department refused to defend the ACA against many of the plaintiffs’ claims. They filed a legal brief arguing that Congress’s repeal of the ACA tax penalty provision caused the individual mandate, guaranteed issue and community rating provisions to become unconstitutional. (The Justice Department’s position diverges from the plaintiffs’, as Justice maintained that the Medicaid expansion and other ACA provisions would not be affected by a finding that the individual mandate is unconstitutional.)

Eleven friend-of-the-court briefs were filed in support of the ACA last week by health care constituencies including insurers, doctors, hospitals, and patient advocacy groups. California Attorney General Xavier Becerra will be leading the law’s defense on behalf of 17 state attorneys general, including Washington’s Bob Ferguson.

If the lawsuit is successful, people with pre-existing conditions would suffer and purchasing coverage on the individual market would be far more complicated and time-consuming. It would look much like the pre-ACA market. Senate Majority Leader Mitch McConnell says the Senate supports coverage for pre-existing conditions. Our Insurance Commissioner, Mike Kreidler, concluded “If the challenge prevails, our country will take a giant step backward.”