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The Affordable Care Act Is Not Jenga. It’s Not a Game. Period.

Photo Credit: Joe Raedle / Getty
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Since Donald Trump became president, he and his allies in Congress have been treating the Affordable Care Act (ACA) like a game of Jenga. But instead of keeping the tower from falling, they’ve been trying to figure out which blocks to remove so the whole thing comes crashing down.

They may have finally succeeded.

Last month, a federal judge in Texas ruled the entire law unconstitutional after finding its individual mandate to be unconstitutional. The individual mandate is the part of the law that requires every taxpaying American to buy health insurance.

The judge, Reed O’Connor of the U.S. District Court in Fort Worth, could not possibly have ruled the same way a year before. Or at any time going back to 2012, when the U.S. Supreme Court affirmed the individual mandate’s constitutionality based on the government’s power to tax and to impose a penalty on those who don’t buy health coverage.

He can do so now because of the Tax Cuts and Jobs Act of 2017, also known as the Republican tax cut for the wealthy, powerful and well-connected. After failing during Trump’s first year to repeal the ACA, Trump and Republicans in Congress settled for eliminating the individual mandate as a tax penalty. In other words, people still had to buy health insurance but were no longer penalized if they didn’t.

This was the Jenga move that now threatens the entire law.

O’Connor wrote that the individual mandate “can no longer be sustained as an exercise of Congress’s tax power.” And because the mandate is essential to the law, he wrote, the entire law is invalid.

A group of state attorneys general is appealing O’Connor’s ruling. The ACA remains in effect as the appeal make its way through the legal system.

If higher courts side with O’Connor and strike down the ACA, the impact the country will be sweeping.

According to the Kaiser Family Foundation, “More than eight years after enactment, ACA changes to the nation’s health system have become embedded and affect nearly everyone in some way. A court decision that invalidated the ACA, therefore, would also affect nearly everyone in at least some way.”

That includes, according to Kaiser’s analysis:

It would also mean no more preventive screenings under Medicare without a co-pay, making it harder for the elderly to afford life-saving procedures like mammograms and colonoscopies.

Trump and his congressional allies should stop playing with the lives of their fellow Americans. There is too much at stake.

As AFSCME President Lee Saunders put it following the December ruling in Texas v. Azar, “It’s time to end the attacks on millions of Americans’ health care.”