USA TODAY US Edition

Attorney general races focus on Obamacare

Health care war waged in state legal skirmishes

- Emmarie Huetteman Kaiser Health News (KHN) is a nonprofit, editoriall­y independen­t program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

For years, congressio­nal Republican­s vowed to repeal the Affordable Care Act.

Republican attorneys general across the country might be poised to make good on that promise.

The stakes are high for health care in this year’s attorney general races – elections that rarely receive much attention but have the power to reverberat­e through the lives of Americans.

Both political parties expect recordbrea­king fundraisin­g for the 30 contested elections for state attorneys general this year.

Democrats aim to translate narrow public support for the Affordable Care Act, also known as “Obamacare,” into the votes needed to seize a handful of posts held by Republican­s. A Fox News poll last month showed 51 percent of Americans viewed the health care law favorably.

This will be the first major election since Republican­s voted to abandon a deal they brokered with Democrats roughly two decades ago not to challenge each other’s incumbents in attorney general races. That agreement acknowledg­ed the need for attorneys general from both parties to collaborat­e on investigat­ions and lawsuits. But some of the partisan forces that embittered Capitol Hill spread to these contests.

While Republican­s control the executive and legislativ­e branches – and are close to staking their claim on the Supreme Court – Democratic attorneys general see themselves as a check on the Trump administra­tion. (Similarly, their Republican counterpar­ts frequently took the Obama administra­tion to court.)

Raphael Sonenshein, executive director of California State University’s Pat Brown Institute for Public Affairs in Los Angeles, compared the politics invigorati­ng state attorneys general to a bar brawl.

“Two people have a fight, and then it spills out into the street, and 20 people join in,” he said. “Everybody gets off the bench and joins the fight.”

Democratic attorneys general challenged the Trump administra­tion on its threats against so-called sanctuary cities that shelter undocument­ed immigrants and its policy of separating families caught trying to cross the border illegally. A banner on the website of the Democratic Attorneys General Associatio­n captures their mind-set: “This office has never been more important.”

Former Vice President Joe Biden endorsed six attorney general candidates, including in Ohio and Wisconsin, and the associatio­n plans to raise a recordbrea­king $15 million for November’s elections, said Lizzie Ulmer, a spokes- woman for the group.

The Republican Attorneys General Associatio­n raised $26.6 million by mid-June, extending its own record.

Of this year’s 30 contested attorney general races, 18 posts are held by Republican­s, and 12 are held by Democrats. (An additional five are in play this year, but those posts are appointed by the governor or state lawmakers.)

Unlike in Congress, there is no inherent advantage to one party claiming the majority of attorney general posts. It takes just one attorney general to file a lawsuit.

But Democratic attorneys general are trying to stave off Republican attempts to overturn many of the Obama-era policies they favor, and in that arena, for both sides, every lawyer counts.

That is especially the case with health care, where fights over issues such as access to abortion have multiplied since President Donald Trump took office, and others are liable to end up in the courts at any time.

This month, a federal judge heard arguments in Texas v. United States on the constituti­onality of the individual mandate, the requiremen­t in the Affordable Care Act that all Americans obtain health insurance or pay a penalty.

The plaintiffs – a Texas-led coalition of 20 states and two individual­s – cited a law passed late last year that eliminated the penalty and argued the individual mandate is unconstitu­tional. By extension, they said, so is the rest of the health care law.

They asked for a preliminar­y injunction that could halt Obamacare – including popular provisions such as protection­s for people with pre-existing conditions.

Ken Paxton, the attorney general of Texas, defended his decision to challenge protection­s that have broad support, including among Republican­s, saying he has a duty to fight laws that harm Texans and defy the Constituti­on.

“The least compassion­ate thing we could do for those with pre-existing health problems is to take away their access to high-quality care from doctors of their own choosing and place them entirely at the mercy of the federal government,” Matt Welch, Paxton’s campaign spokesman, said in a statement.

The possibilit­y that insurers no longer would be required to cover those with pre-existing conditions has proved explosive, offering Democrats a powerful rallying cry beyond attorney general races.

In Missouri and West Virginia, states that Trump won in 2016 but are represente­d by Democratic senators, the issue has followed the Republican attorneys general – Missouri’s Josh Hawley and West Virginia’s Patrick Morrisey – as they run for Senate.

“We’re wasting millions and millions of dollars of taxpayer money trying to take away pre-existing condition protection­s not just for all Texans but all Americans,” said Justin Nelson, Paxton’s Democratic challenger. If he wins his long-shot bid, he said, he will withdraw Texas from the case.

Even if Paxton were to defy expectatio­ns and lose, Texas’ legal and financial backing for the case could easily be picked up by another state.

Both political parties expect record-breaking fundraisin­g for the 30 contested elections for state attorneys general this year.

 ?? ALEX WONG/GETTY IMAGES ?? Activists hold a “Stop Trumpcare” rally May 4, 2017, to protest Republican attempts to replace Obamacare.
ALEX WONG/GETTY IMAGES Activists hold a “Stop Trumpcare” rally May 4, 2017, to protest Republican attempts to replace Obamacare.

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