Health-care debate front and center again for 2020

We are still months from the first votes being cast in Iowa, but the 2020 campaign is already well underway. The Democratic field is nearly set and the uncertain specter of the Mueller probe has mostly cleared the president and his team on the collusion narrative.

So why would an administration — hot off one of the president’s critical victory laps — announce in a legal filing before the 5th circuit last week that it was backing a full invalidation of the Affordable Care Act?

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President Trump was hedging his bets late Monday evening tweeting, “The Republicans…are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare. Vote will be taken right after the election when Republicans hold the Senate & win back the House.”

But the damage is done. President TrumpDonald John TrumpTrump faces high stakes in meeting with Erdoğan amid impeachment drama Democrats worry they don't have right candidate to beat Trump Trump threatening to fire Mulvaney: report MORE has placed the health-care debate front and center heading into the 2020 elections, and there is a very good change it will have implications beyond his own reelection prospects.

Many congressional Republicans are rightly fearful of this new legal assault on the Affordable Care Act, especially without a legislative response ready in the wings if the lawsuit is successful.

In 2018, 1 in 2 Americans lived in a household where a family member has a pre-existing condition that is protected under current law.

Eight years ago, the GOP successfully flipped 63 seats in a wave election that captured the sense of frustration felt by many Americans in the wake of the passage of the Affordable Care Act. Nearly half (48 percent) of midterm voters in 2010 wanted to see the law passed just months earlier repealed in earnest.

During the 2018 midterms, more than 4 in 10 voters (41 percent) listed health care as the most critical issue facing the country — nearly double the number of voters who listed immigration (23 percent) or the economy (22 percent) in CNN exit polling. It’s clear that health care has been the defining issue on the minds of voters in 2010 and 2018.

In 2016, one of the determining factors in President Trump’s surprise victory was his support among white women, who made up 37 percent of the electorate. He won them 9 points over Hillary ClintonHillary Diane Rodham ClintonDemocrats worry they don't have right candidate to beat Trump Krystal Ball credits Gabbard's upswing in 2020 race to 'feckless' Democratic establishment Outsider candidates outpoll insider candidates MORE. Just two years later, however, white women split their votes in half: 49 percent for Republicans and 49 percent for Democrats.

To make matters worse, Trump lost married women by only 2 points to Clinton, but in 2018 the GOP lost them by more than 10 points. Most of this Republican defection occurred in key suburban districts that propelled Democrats to retake the house and Nancy PelosiNancy PelosiGiuliani pens op-ed slamming 'unprecedented' impeachment inquiry Brindisi, Lamb recommended for Armed Services, Transportation Committees Overnight Health Care: Top health official defends contract payments to Trump allies | Vaping advocates confident Trump will turn from flavor ban | Sanders gets endorsement from nurses union MORE to recapture the speaker’s gavel.

There is some silver lining in the 2018 CNN exit polling for Republicans. Sixty-nine percent of midterm voters said that the current health-care system needs “major changes.”

The DOJ announcement certainly would be a major change to the system — a total and complete invalidation of the ACA, including striking down key provisions like protections for preexisting conditions to voiding the expansion of Medicaid in most states.

This is a gamble the president and Republicans in congress cannot afford to make. With no substitute in place, a ruling by the 5th circuit throwing out the ACA would lead to huge uncertainty in the health-care marketplace, millions of Americans losing their coverage through Medicaid, seniors across the country ineligible for no-charge preventive services and the GOP owning the number one motivating issue heading into 2020.

Kevin Walling is a Democratic strategist, vice president at HGCreative, co-founder of Celtic Strategies, and a regular guest on Fox News and Fox Business. Follow him on Twitter: @kpwalling