Republicans, Democrats appear headed for more battles on Affordable Care Act

Leading U.S. House Democrats, backed by Speaker Nancy Pelosi, are unveiling broad legislation to shore up the Affordable Care Act, an attempt to deliver on campaign promises about health care and to — just maybe— change the conversation.

In Washington, a capital city consumed with the political storm over special counsel Robert Mueller's Russia report, Democrats are trying to show they also care about policy by falling back on an issue that worked well for them in last year's midterm elections.

According to Pelosi's office, the bill being unveiled Tuesday would make more middle-class people eligible for subsidized health insurance through former president Barack Obama's health law (Obamacare) while increasing aid for those with lower incomes who already qualify. And it would fix a longstanding affordability problem for some consumers, known as the "family glitch."

The legislation would provide money to help insurers pay the bills of their costliest patients, and restore advertising and outreach budgets slashed by President Donald Trump's administration, helping to stabilize health insurance markets.

It also would block the Trump administration from loosening Obamacare rules through waivers that allow states to undermine protections for people with pre-existing medical conditions or to scale back so-called "essential" benefits like coverage for mental health and addiction treatment.

The bill will get a vote in the House, but as a package, it has no chance of passing the Republican-controlled Senate. However, some elements have bipartisan support and may make it into law.

Pelosi slams latest government court filing

The bill comes just as Trump's administration has said in a legal filing it wants the entire ACA struck down.

In a filing Monday with a federal Appeals Court in New Orleans, the administration said the entire law should be struck as unconstitutional. It's rare for the Justice Department to decline to defend a federal law.

Previously, the administration had called only for parts of the law to go.

The Justice Department is expected to elaborate on its position in a brief to the Appeals Court. In a letter, it said the court should affirm a December decision by U.S. District Judge Reed O'Connor in Fort Worth, Texas. O'Connor ruled that Congress's elimination of penalties for not buying health insurance rendered the law unconstitutional.

The ruling rests on a legal analysis that the coverage requirement and its fines remain central to the law. O'Connor noted the Supreme Court upheld the law in 2012 because the mandate was enforced through fines that passed constitutional muster, since they were levied as taxes.

With the fines gone, the coverage requirement can no longer be considered constitutional, he reasoned, and the entire health law is defective because it can't be separated from the coverage requirement.

In a tweet, Pelosi characterized it as "all out war on affordable, dependable health care."

Trump swept into office promising to "repeal and replace" the Obama health law, but was unable to do so, even with a Congress fully under Republican control. He has continually scapegoated John McCain for his part in rejecting an attempt to overhaul health care, even doing so after the revered senator died last year.

Meanwhile, millions of people continue to benefit from the ACA's taxpayer-subsidized private insurance plans, but enrolment is slowly declining and experts fear stagnation.

The government said Monday that 11.4 million people have signed up for coverage this year, just a slight dip from 2018. The Centers for Medicare and Medicaid Services found remarkably steady enrolment, down only about 300,000 consumers. Premiums stabilized, and more insurers came into the market.

Still, the number of new customers fell by more than 500,000. That's a worrisome sign for backers of the ACA, who say the Trump administration's cuts to the ad budget and congressional repeal of a requirement that people get insured will gradually eat away at program enrolment. Unless younger, healthier people sign up, already-high premiums will march upward again.

Since Trump took office, the federal health insurance market, HealthCare.gov, has lost more than one million customers. State-run markets are holding their own.