WASHINGTON — After a federal judge ruled that the Obama-era health overhaul was "invalid," President Donald Trump is looking to congressional leaders to come up with a replacement even as the White House says the current law will remain in place for now.
"Get it done!" the president instructed Senate Majority Leader Mitch McConnell, R-Ky., and Rep. Nancy Pelosi, D-Calif., the likely House speaker in January.
Legal appeals are expected to reach the Supreme Court on an issue that helped propel Democrats to their new majority in the House in the recent midterm elections.
In a 55-page opinion Friday, U.S. District Judge Reed O'Connor in Texas ruled that last year's tax cut bill knocked the constitutional foundation from under the Affordable Care Act by eliminating a penalty for not having coverage. He wrote that the rest of the law cannot be separated from that provision and therefore was invalid.
Supporters of the law said they would appeal. "Today's misguided ruling will not deter us: Our coalition will continue to fight in court for the health and well being of all Americans," said California Attorney General Xavier Becerra, who is leading a coalition of states defending the overhaul.
The White House applauded the ruling by O'Connor, who was appointed by President George W. Bush, and said that "pending the appeal process, the law remains in place."
President Trump tweeted that "Obamacare has been struck down as an UNCONSTITUTIONAL disaster!" and said it was not up to Congress to "pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions."
While congressional Republicans held their silence in reaction to the ruling, Democrats said they would test the GOP's commitment to such popular provisions.
"The GOP spent all last year pretending to support people with pre-existing conditions while quietly trying to remove that support in the courts," Senate Democratic leader Chuck Schumer of New York said in a tweet Saturday. "Next year, we will force votes to expose their lies."
Pelosi said the House "will move swiftly to formally intervene in the appeals process to uphold the life-saving protections for people with pre-existing conditions and reject Republicans' effort to destroy" the law.
But Congress is unlikely to pass a new law while the case remains in the courts. Numerous high-ranking Republican lawmakers have said they did not intend to also strike down provisions such as protection for people with medical conditions when they repealed the law's fines for people who can afford coverage but remain uninsured.
Legal expert Timothy Jost, a supporter of the health law, said O'Connor's ruling would have repercussions for nearly all Americans if it stands. If the entire health law is invalidated, popular provisions that benefit Medicare beneficiaries and people with employer coverage would also be scrapped. That could include the section that allows parents to keep young adult children on their coverage until age 26.
About 20 million people have gained health insurance coverage since the law passed in 2010 without a single Republican vote. Currently, about 10 million have subsidized private insurance through the health law's insurance markets, while an estimated 12 million low-income people are covered through its Medicaid expansion.
Saturday was the sign-up deadline for 2019 private plans through HealthCare.gov. Meanwhile, a number of states are expected to move forward with Medicaid expansion after Democratic victories in the midterm elections.
If the case were to reach the Supreme Court it would mark the third time the justices consider a challenge to fundamental provisions of the law. The law's opponents lost both the first two cases.
The five justices who upheld the health law in 2012 in the first major case — Chief Justice John Roberts and the court's four liberals — are all still serving.
Since then, public opinion on the overhaul has shifted from mostly negative to generally favorable.
Preserving the law's protections for people with medical conditions proved to be a strong argument for Democrats in the November elections. Republicans who tried to undermine those safeguards during their failed effort to repeal the health law last year were forced on the defensive and went on record saying they, too, want to make sure people with health problems can get coverage.
House Democrats are talking about passing legislation that enshrines protections for medical conditions. It's unclear what form that would take, or if the Republican-majority Senate would go along and President Trump would sign it.
The GOP-led states that had sued asked O'Connor to toss out the entire law after Congress repealed the "individual mandate" penalty for going without coverage. The judge had previously ruled against other Obama-era policies.
The Trump administration weighed in, saying the government would no longer defend some core components of the law, but that others could remain, including Medicaid expansion, subsidies for private insurance and health insurance markets.
Along with the requirement to have health insurance, the administration said the parts of the law that should go included:
—the requirement that insurers must take all applicants for comprehensive coverage regardless of prior health history, including existing conditions. That includes a prohibition on insurers writing policies that exclude a particular condition — for example, a recurrence of breast cancer.
—the prohibition on insurers charging higher premiums to people with health problems.
The health insurance industry says doing away with consumer protections will destabilize a market that seems to be finding its footing, with modest premium increases and more plan choices next year.
The American Medical Association called O'Connor's ruling an "unfortunate step backward for our health system that is contrary to overwhelming public sentiment to preserve pre-existing condition protections."