In six separate filings, supporters outline the “extraordinary financial and human costs” to millions of Americans caused by President Trump’s relentless and “methodical dismantling” of the Affordable Care Act.

The U.S. House of Representatives, 20 states, 13 cities and counties, four advocacy groups, health insurance marketing expert Joshua Peck, and health economist Henry Aaron filed six “friend of the court” briefs in support of our lawsuit on behalf of the cities of Columbus, Baltimore, Cincinnati, Chicago, and Philadelphia, and two Charlottesville residents, challenging President Trump’s deliberate and unlawful sabotage of the Affordable Care Act.

President Trump’s attacks have raised premiums and made quality health insurance plans harder to access for millions of Americans. By intentionally sabotaging the ACA, President Trump is violating his constitutional duty to “take care that the laws be faithfully executed.”

Administration’s Sabotage Campaign Described as “Death by A Thousand Cuts” Intended to “Undermine Congress’s Goal” of Expanded Health Care Coverage

In its brief, the U.S. House of Representatives explained that “Congress passed the Affordable Care Act in response to serious problems plaguing America’s health care system,” and that the law was intended “to expand coverage while keeping health care costs in check.” Despite the fact that the ACA has been “remarkably successful,” “the President and his Administration have taken various actions to undermine the Act and thwart its achievement of the important public health goal of near-universal coverage.” The brief details the steps the Trump administration has taken to “undermine Congress’s goal” in enacting the ACA, including removing the requirement that exchanges provide “standardized options” (which make it easier for consumers to compare plans), ending the requirement that Navigators have a physical presence in the area they serve, shortening the open enrollment period, and reducing funding for outreach and advertisements. “In other words, in myriad ways, this Administration has tried to make it more difficult for individuals who need health insurance to access it through the Exchanges, even though Congress passed the Affordable Care Act to accomplish the opposite goal.”

California, 18 other states, and the District of Columbia describe “the profound and destabilizing impact of this administration’s systematic efforts to impede the…ACA.” Many of the Amici States are seeing a rise in health insurance premiums and an increase in the number of uninsured residents, which have caused individuals to turn to safety-net sources of care such as hospital emergency rooms and free clinics to meet their healthcare needs. “But such uncompensated care—a direct result of this administration’s policies—is not free.” Prior to the ACA, California incurred uncompensated care costs of more than $3 billion dollars, and once the ACA was fully implemented California’s uncompensated care costs dropped to $1.44 billion. “It is axiomatic that when the number of uninsured individuals rise, uncompensated care costs rise as well,” the Amici States explain. This imposes “a serious financial strain on state and local government coffers.” As result of the Trump administration’s “methodical dismantling of the ACA, one piece at a time,” the “Amici States, and their residents, are paying a steep price[.]” The states conclude that the “Trump Administration’s unremitting efforts to dismantle the ACA should be halted.”

Similarly, the cities and counties brief, led by the County of Santa Clara, California, explains how essential the ACA is in reducing costs to local governments. The municipalities explain that despite their differing demographics and regions they are “united in our support for the Affordable Care Act.” As they note, “[the Trump administration’s] attempts to sabotage the ACA and make it fail impose extraordinary financial and human costs… leaving us worse off in some ways than we were even before the ACA was enacted.” As the municipalities state, “it is improper for the President and his officers—charged with upholding the law—to undermine it and to unilaterally effect profound public harm to our nation’s health and health care system.”

In the brief filed by advocacy organizations and the SEIU– the largest health care union in the United States–the groups reiterate the humanitarian toll that President Trump’s repeated acts of sabotage have inflicted on their members and the communities they serve. Focusing on the effects of the Administration’s actions on low-income communities in particular, the groups assert that, “The Trump Administration has taken steps that are contrary to the goals of the ACA and have started to move the country backwards,” and highlight the ways that “President Trump and his Administration are waging a relentless campaign to sabotage and ultimately to nullify the [ACA].”

Joshua Peck, the co-founder of Get America Covered and the former Chief Marketing Officer for Healthcare.gov at the Centers for Medicare & Medicaid Services (CMS), writes in his brief that “contrary to the ACA’s goal and CMS’ regulatory mandate,” the administration took action—“knowing and intentional” action—to substantially depress enrollment in health insurance plans through HealthCare.Gov. Peck describes his testimony before a Congressional committee regarding documents Democracy Forward obtained through a Freedom of Information Act request, which suggest that CMS knew that cutting television outreach advertising for HealthCare.Gov “would be especially harmful to enrollment.” The administration reviewed CMS studies to this effect prior to cutting ACA advertising funds, and “went so far as to deny the existence of CMS’ studies when trying to justify their harmful conduct, claiming that ‘[n]o correlation has been seen between Obamacare advertising and either new enrollment or effectuated enrollment.’”

The brief by Brookings Senior Fellow Henry J. Aaron, an esteemed health economist, lists the numerous obstacles the administration has placed in the way of consumers seeking to obtain affordable health insurance. As he states, the administration’s “actions will divert enrollment from ACA-compliant plans in a manner antithetical to Congress’s intent in enacting the ACA. Those measures will increase the cost of ACA-compliant insurance. They will cause consumers either to forgo health care or to seek uncompensated care, much of it from jurisdictions like the plaintiffs, which support health care providers of last resort. In short, the measures described here clash fundamentally with congressional intent as expressed in the ACA.”

We have asked that the court order the President to take certain steps to faithfully execute the ACA, including by restoring funding for advertising and for healthcare Navigator groups, expanding open enrollment periods, and promoting the availability of comprehensive, reasonably-priced health insurance for individuals and families with preexisting conditions. The government has sought to have the case dismissed; plaintiffs laid out their opposition in a filing on May 31. Amici in the case have urged the court to deny the government’s motion to dismiss.

The amicus briefs were filed on Friday, June 7, 2019 by: