Legal threat to ACA ought to be front and center in 2020 election

Minnesotans who buy health insurance on their own still have until midnight Monday to buy 2020 coverage through MNsure and qualify for financial aid to make monthly premiums more manageable. A legal ruling handed down on Wednesday created massive uncertainty about the Affordable Care Act's future. But the consumer subsidies and other reforms established by the landmark health law, such as protections for people with pre-existing conditions, remain in place for now.

Whether the same will be true a year from is lamentably up in the air, creating uncertainty for the 20 million Americans who have come to rely on the law to cover themselves and their families. The Affordable Care Act (ACA), which has already survived two constitutional challenges fought all the way to the U.S. Supreme Court, faces a third legal threat to its existence. This latest lawsuit is led by attorneys general for Texas and other Republican-leaning states. They argue that the entire law must be scrapped because its "individual mandate" to buy health insurance is no longer enforceable after Congress reduced the financial penalty to $0 in 2017.

Those who have followed ACA legal battles understandably feel exasperated. The first lawsuit mounted by the ACA's opponents contended it was unconstitutional because of the requirement to buy insurance. Now, this latest challenge contends the entire law must be struck down because it essentially lacks a mandate to buy insurance.

A judge in the Northern District of Texas bought this dubious argument in late 2018. The decision was quickly appealed. Both the law's proponents and opponents have waited for months for a ruling from the Fifth Circuit in New Orleans. A three-judge panel finally ruled on Wednesday while the historic debate over impeaching President Donald Trump played out in Congress. In a 2-1 vote, the panel essentially agreed with the lower court, but then kicked the case back to the district court judge to have him decide which parts of the law should be thrown out.

The ruling's timing puts it at risk of being overshadowed by the drama in Washington, D.C. But the nation can ill afford to simply set this aside. Overturning a law that's been in place for nearly a decade would result in serious disruption of the nation's health care system. What would happen to the nearly 13 million low-income Americans who became newly eligible for Medicaid coverage under the ACA? How would families who rely on the ACA's subsidies to buy insurance continue to afford it? Would there be another program to help seniors who found prescription drug cost relief through the ACA's closure of the Medicare "doughnut hole"?

Other popular reforms tied to the ACA's fate: keeping young people on parents' insurance plans until age 26, and eliminating out-of-pocket preventive care costs. Enhanced federal funding for a state program — MinnesotaCare, which provides coverage for working families — is also at risk.

ACA proponents are pursuing options to swiftly bring the case before the U.S. Supreme Court. It's also not clear how long it might take the lower court judge to sort out which parts of the ACA, if any, survive.

What could happen and what should be done to protect consumers ought to be front and center in the 2020 election. So far, the Democratic presidential campaign has focused on idealistic solutions, such as a government-run Medicare for All program. A more down-to-earth approach is now needed to keep the health care we have if the ACA goes away.

But it's President Donald Trump and Republicans who should shoulder the responsibility for planning for the chaos the law's demise could cause. Eliminating the ACA has been something close to a GOP political holy grail. Yet replacement plans offered up, such as those authored by Congressional Republicans in 2017, would result in far fewer Americans having insurance. The ACA is in real jeopardy. Those who put it there owe the nation a serious game plan to clean up the mess they worked to create.