Health care will define the midterms

Donald Trump and the Republican Party just put America’s health care squarely on the November ballot. After trying and failing to repeal the Affordable Care Act, the Trump administration, in cahoots with 20 conservative states, has asked the courts to strike down several pillars of the ACA — including its protections for Americans with pre-existing health conditions.

These protections are a guarantee to as many as 130 million Americans that no insurance company can deny them coverage just because they (or one of their family members) had a prior illness or medical problem. They are wildly popular, supported by majorities of both Democrats and Republicans.

Trump himself has promised to preserve that part of the law. In legal papers filed Thursday, however, his administration urged a Texas court to wipe these protections from the books.

It is rare for an administration to refuse to defend a federal law. This case is even more remarkable because overturning the ACA would harm tens of millions of Americans.

The administration’s argument is tied to the new tax law. Republicans removed the penalty for people who can afford to buy insurance but choose not to — the “individual mandate” — but they didn’t repeal the rest of the ACA. The administration now says the mandate was unconstitutional and wiping it out requires invalidating other parts of the ACA, including the part protecting people with pre-existing conditions. It argues those parts can’t be “severed” from the mandate and must also be unconstitutional.

We can’t blame you if your reaction to that is “huh?” We have a fair amount of legal and health care experience directly related to this law, and that’s our reaction, too. The logic is so tortured and the claims are so weak that the lawsuit is widely considered frivolous.

Have a headache trying to follow this? Does it make you a tad depressed or anxious? Be careful. If the Trump administration has its way, insurers could soon deny you coverage for those preexisting conditions. The same would be true for serious prior illnesses such as cancer, diabetes and heart disease.

The Justice Department has asked the court to keep pre-existing protections in place through 2018 — conveniently after the midterms, so voters may not fully recognize on Election Day what Republicans have in store for them. Sixteen states and the District of Columbia have already stepped up to defend the law. The case could eventually wind its way to the Supreme Court.

In the meantime, insurance companies, which have already raised rates by double digits this year due to Republican sabotage, now have cause to raise them further.

The midterm election politics appear very bad for congressional Republicans. Already, some are attempting to distance themselves from the administration’s actions. But they have only themselves to blame for the position they are in. Their first choice both before and after Trump became president was a straight repeal of the ACA. The Trump administration is just following through on what most Republicans said they wanted from the beginning.

Congressional Republicans should be called on to explain how they have helped Americans care for their families. Democrats should now challenge even individually popular Republicans on the premise that their party doesn’t deserve to control Congress. Democrats can also argue that only a Democratic Senate can assure that a conservative Supreme Court won’t play politics in a case like this one.

Nothing has defined the domestic agenda over the past 18 months like health care. It’s only fitting that it will define the election, too.

Andy Slavitt, board chair of United States of Care and a member of USA TODAY’s Board of Contributors, ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015-17. Nicholas Bagley is a University of Michigan law professor and a former Justice Department attorney.