Trump’s response to the Obamacare ruling reveals his bind on health care

Even as President Donald Trump cheered a Friday federal court ruling that declared Obamacare unconstitutional, he was already calling for a new law that would reinstate some of the popular provisions that Texas v. United States was looking to undo, including protections for preexisting conditions.

He turned to Twitter to ask Congress for a replacement: a “STRONG law that provides GREAT healthcare and protects pre-existing conditions.” He directed Senate Majority Leader Mitch McConnell and soon-to-be House Majority Leader Nancy Pelosi to “get it done.”

Earlier Friday evening, a federal judge in Texas found that since a 2017 tax bill removed the fine for remaining uninsured, the individual mandate was now unconstitutional. (It was originally upheld in the Supreme Court as a “tax,” but without a penalty, can no longer be considered so, US District Judge Reed O’Connor found.) Twenty state attorneys argued in a lawsuit partially supported by the Trump administration that the entire Affordable Care Act has to go, too. O’Connor agreed.

“The Court finds the Individual Mandate ‘is essential to’ and inseverable from ‘the other provisions’ of the ACA,” the judge wrote in the Friday ruling.

Trump claimed late Friday that he had predicted “all along” that Obamacare would be struck down as unconstitutional. “All along” is a vague and questionable claim, as the unconstitutionality ruling, which is expected by many to be overturned, relies on Congress’s 2017 tax bill, which ended the financial penalties for remaining uninsured.

Trump also called the outcome “great news for America!” But while his administration had partially supported the attorney generals’ lawsuit, the Justice Department didn’t actually want the outcome to go this far. As Vox’s Sarah Kliff writes, the Trump administration “took a different approach”:

It agreed with the conservative states that the mandate and, with it, the law’s rules that prohibit insurers from denying people health insurance or charging them higher rates, should be found unconstitutional.

However, the Justice Department lawyers didn’t go quite as far as the state attorneys general. They told the court that the rest of the law could stand, including the law’s massive expansion of Medicaid to millions of the nation’s poorest citizens.

And despite the president’s political bravado, the White House has assured the public that the ACA will remain in effect while the ruling is being appealed. In a statement released late Friday, the White House wrote that: “We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place.”

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, also took to Twitter to assure people that they could still sign up. (Today’s the deadline to sign up for 2019 coverage.)

While the repeal of “Obamacare” is an ideologically important goal for Republicans — so much so that the Republican-controlled House spent seven years trying to undo it — its complete repeal would be politically disastrous for the Trump administration.

There’s a reason Trump is arguing for a new law that protects preexisting conditions: Many of the ACA’s provisions are extremely popular.

And as noted above, the Justice Department actually wants the Medicaid expansion to stand, because without it, millions of people will lose access to health care under Trump’s watch. This, as Vox’s Ezra Klein points out, would come “mere weeks after Republicans lost a midterm election for merely trying to cut those people off health insurance.”

It’s not clear what the Trump administration will do next, or who will appeal on behalf of the law. While the administration did not defend the ACA in court, a group of attorneys general from 16 pro-Obamacare states and the District of Columbia stepped in to defend the law, and California Attorney General Xavier Becerra has already vowed to appeal the decision, according to Politico, though it’s not clear when.

But Trump himself appears to be calling for a new law, or even a stronger one, and he’s not alone.

As Klein argued on Friday, the GOP’s continued assault on the Affordable Care Act is actually a strong argument for Democrats gunning to implement some version of Medicaid-for-all. Just imagine: “a universal health care system simple enough and popular enough that it is safe from constant political and legal assault.”