The case is being defended by a coalition of 17 Democratic attorneys general, and an amicus brief was filed in June by Families USA, Community Catalyst, the National Health Law Program, the Center on Budget and Policy Priorities and the Center for Public Policy Priorities in Texas.
Alongside a group of 20 states, Attorney General Ken Paxton sued in February to end the law, arguing that Congress had eliminated a key provision in the legislation when it passed the 2017 Tax Cuts and Jobs Act.
Here are five questions and answers to help understand the case, Texas v. U.S. The Justice Department agrees that the individual mandate is rendered unconstitutional but argues that invalidates only the law's protections of those with pre-existing conditions. They are using the Supreme Court's 2012 ruling upholding the ACA as a tax law as the basis for their argument: With the tax penalty zeroed out as part of last year's tax reform, the entire law should be vacated. "They don't have the protections of the Affordable Care Act".
"Texans and other Americans should be free again to make their own health care choices", said Republican Texas Attorney General Ken Paxton, who is leading the court challenge. Nineteen other states and other plaintiffs have joined Texas. That worry topped other sources of anxiety related to health care, including deductibles, drug costs and insurance premiums. Half of those people said the bill was less than $500, but almost 1 in 8 said they were on the hook for $2,000 or more.
During the hearing, O'Connor returned repeatedly to arguments that architects of the health care law made in 2010 and afterward that requiring people to have insurance was critical to the popular consumer protections in the law, including bans on insurance companies turning away sick customers or charging them higher premiums, practices that were commonplace before the health care law was enacted.
The case has always been considered a tough one for the plaintiffs, who have to prove the now-gutted, zero-dollar individual mandate is an essential part of the ACA and argue that Congress' vote to eliminate the individual mandate was a vote to repeal the landmark law altogether.
O'Connor did not issue a preliminary injunction, which even the Trump administration had opposed, even though it supports some elements of the Republican states' case. An insurance attorney with ties to the case said for insurers the sweeping impact of a reversal of the entire law would deal a hefty blow to insurers of Medicaid, Medicare and all the aspects of the healthcare industry touched by the ACA.
Three in 10 of voters (30%) say Washington corruption is the "most important" topic for candidates to discuss, with health care (27%) and the economy and jobs (25%) close by.
"Absent the individual mandate, the ACA is an irrational regulatory regime", the plaintiffs argue in court papers.
Yet the judge suggested he ought to look at the Affordable Care Act as written, which seemed to tether the mandate to rules that force insurers to cover people with preexisting conditions and charge them the same as healthy people. Three Democrats in the meetings told the Times that Kavanaugh suggested that if one piece of the law is struck down, the rest of the law doesn't necessarily have to fall with it.
However, their popularity is one of the main reasons GOP lawmakers had such difficulty repealing Obamacare a year ago and it has given Democrats fodder for attacking Republican rivals in the midterm elections.
Critics, however, were quick to point out that the bill doesn't actually offer the same protections that are embodied in the ACA. The team compared changes in health insurance coverage and access to and use of health care services among Latinos ages 18 to 64 before implementation of the main provisions of the Affordable Care Act (2007-2013) and after (2014-2016). The latest tracking poll from Kaiser Family Foundation found 75% of Americans believe it is "very important" to retain the ACA's protections for people with pre-existing conditions.