• Some 20 million uninsured Americans gained coverage under the Affordable Care Act
  • Opinions on the law have shifted in the last decade with half of Americans now approving of the law
  • The Supreme Court is scheduled to rule on a case brought by a group of Republican attorneys general that seeks to overturn the law

President Donald Trump has finally presented his vision for a comprehensive health insurance of Americans – Obamacare, despite continuing administration efforts to overturn the health insurance system that covers some 20 million Americans.

Trump signed an executive order Thursday, reaffirming protections for preexisting health conditions that already are protected by the Affordable Care Act.

“The historic action I’m taking today includes the first-ever executive order to affirm it is the official policy of the United States government to protect patients with preexisting conditions,” Trump said even though the ACA established the coverage a decade ago and federal law takes precedence over executive orders. “We’re making that official. We’re putting it down in a stamp, because our opponents, the Democrats, like to constantly talk about it.”

The ACA was enacted to help nearly 47 million Americans without health insurance at the time to gain coverage. By 2016, the number of uninsured had dropped to less than 27 million, but the number has risen since, and job losses as a result of the coronavirus pandemic has exacerbated the situation.

Trump made repealing and replacing the ACA a hallmark of his 2016 campaign, but he never unveiled his own replacement plan and congressional Republicans failed to coalesce around any proposals. In the interim, the Justice Department has been providing help to states that have challenged parts of the ACA, and the 2017 tax reform law removed the ACA’s individual mandate.

Trump said elimination of the mandate means it’s no longer Obamacare. He signed executive orders in July to lower drug costs and eliminate the middleman from certain transactions. Thursday’s action opened the way for states to import prescription drugs.

A group of Republican attorneys general now is arguing in a case before the Supreme Court that the removal of the mandate nullifies the remainder of the law. They want to eliminate the exchanges on which people have been able to buy private coverage and gut the Medicaid expansion that provided coverage to 13 million people.

The Commonwealth Fund reported last year the remaining uninsured make less than the maximum allowed under Medicaid but live in the 17 states that did not expand their Medicaid programs. Others don’t realize they qualify for subsidies for coverage obtained through the marketplace exchanges.

Americans’ attitude toward the ACA has shifted since the measure was first enacted with half of the public now approving of the law. Some 82% of Democrats expressed a favorable view this month compared with 16% of Republicans, the Kaiser Family Foundation Tracking Poll indicates.