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News Analysis

Trump's Justice Department Just Declared All-Out War on Obamacare. What Does It Mean?

March 29, 2019


Nancy Pelosi  holds a news conference about healthcare legislation

U.S. House Speaker Nancy Pelosi holds a news conference about healthcare legislation on March 26, 2019. (Credit: Tasos Katopodis for Getty Images)


So you may have read that Trump's Justice Department just officially agreed with a conservative federal court judge in Texas who, last December, ruled that the entire Affordable Care Act (ACA, also known as "Obamacare"), which now covers millions of Americans, should be totally killed.

Does that mean it will be? No. The case now goes before the right-leaning Fifth Circuit Court of Appeals in Louisiana, but regardless of how that court rules, the case will almost certainly be appealed to the Supreme Court -- although it's not clear if that would happen before or after the 2020 elections. So for the time being, the ACA is fine -- but it may not always be.

Here, we try to answer some other key questions for you.

What Does This Mean for People Living With HIV/AIDS (PLWHA)?

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PLWHA are big beneficiaries of the ACA in many ways. Many of us (including this writer) get our health care on the private ACA marketplace and either pay for it ourselves, get federal subsidies, or get the AIDS Drug Assistance Program (ADAP) to pay our premiums and copays. The ACA's Medicaid expansion in several states has come to cover health care for an estimated 40% of all Americans living with HIV, so that's huge. Many PLWHA are covered by Medicare, whose patient costs the ACA regulates in many ways. And the ACA protects coverage for people with pre-existing conditions; requires that plans cover certain "essential benefits" such as prescription drugs, labs, and mental health; and prohibits the selling of so-called "junk plans" that give patients precious little protection or coverage for their buck. So obviously all these things are huge not just for PLWHA, but for anyone with pre-existing conditions and/or serious health needs.

"If you're a young adult living with HIV between the ages of 18 and 26, you can stay on your parents' plan under ACA, so you'd lose that," adds Mark Hannay, director with Metro New York Health Care for All. And with the end of Medicaid expansion, which under ACA is mostly federally funded, "most states would probably be compelled to shut down their Medicaid expansion, and a lot of people would be thrown back on ADAP, the payer of last resort for PLWHA, which would be very burdensome on the program." You may remember its funding shortfalls and nerve-racking drug waitlists in the 2000s and even into the 2010s.

Are There Other Ways PLWHA and Others Would Suffer?

Yes. Expanded Medicaid has become a huge payer of treatment for opioid addiction. "That affects a lot of Trump's base," says Hannay.

Speaking of That -- Is This a Politically Smart Move for Trump Going Into 2020?

Discounting Trump's die-hard base of about 30%, who would probably go on supporting him if he pushed them off a cliff, probably not. After Congress, goaded by an explosion of activism, saved Obamacare in 2017, polls throughout 2018 found that it was more popular than ever. It has buoyed the health care industry. And exit polls after the 2018 midterms, which turned the House of Representatives over to the Democrats, showed that voters called health care their top issue.

The Justice Department's recent move is "absolutely outrageous," says Jennifer Flynn, a co-organizer of Birddog Nation, a national grassroots network of activists who hound candidates on health care, funded by Housing Works and the Center for Popular Democracy. "It ignores the hundreds of thousands of people who took action in 2017 to save the ACA -- 10,000 distinct actions nationwide, as reported by [House Speaker, Democrat] Nancy Pelosi. It goes against Trump's own advisers. Both houses of Congress voted down the effort to kill ACA. It's just a stupid move to distract people from the illegal actions of the Trump administration and to terrorize people with pre-existing conditions, which is most of us, and people with disabilities or sick kids."

How Should Democrats Respond?

In fact, they already are. Almost simultaneously with the Justice Department move, House Dems unveiled their new plan to beef up the ACA, including lowering premiums, strengthening protections for people with pre-existing conditions, and banning the sale of so-called "junk insurance." And of course, some Democrats -- including many of the 2020 presidential candidates -- are calling for the passage of Medicare for All, a near-universal, government-funded and -run coverage plan that would scrap not only the ACA and other health programs but would kill most of the private health insurance industry.

Flynn calls that idea "amazing. It would recreate the entire health system so we're never in this [precarious] place again." She adds: "It's useful for people to know that if we keep this issue on the public radar through 2020, [Democrats] will sweep those elections. The blue wave of 2018 was also a health care wave. So we have to keep lifting up the fact that we're doing all we can to get more people health care, while their side is doing all they can to strip it away from desperate people."

So What Can You Do?

A lot. "Tell your representatives and senators to tell the Fifth Circuit not to kill the ACA," says Hannay. "And share your health care stories with local media. You can also on-ramp with local pods of big national groups like Families USA."

But if you want to get really active, consider joining -- or even starting -- your local network of Birddog Nation, which will be confronting both Democrat and Republican candidates at events and forums throughout election season, pinning them down on their positions on both saving the ACA and on broader initiatives like (some version of) Medicare for All. Flynn says to email her directly at jflynn@populardemocracy.org.

"When we birddog candidates on this issue, make it the dominant issue in the elections, it weighs on Trump," she says. "And we know that it matters when people show up at the courts when there's a hearing, when they ask their reps to write to the judge."

In other words, she says, "It's just like after Trump's election. Fine -- freak out, but don't do it alone. Hold meetings and get organized!"

Tim Murphy has been living with HIV since 2000 and writing about HIV activism, science and treatment since 1994. He writes for and has been a staffer at POZ, and writes for the New York Times, New York Magazine, Out Magazine, The Advocate, Details and many other publications. He is also the author of the NYC AIDS-era novel Christodora and the forthcoming novel Correspondents (May 2019).


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The Trump Administration's Drug Pricing Proposals for People With HIV, Explained
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