Five major court battles over Trump's health agenda

The Trump administration has found itself in court time and time again defending the president’s efforts to overhaul the American health care system.

Here’s a rundown of where the major lawsuits stand, from cases challenging the administration’s approval of Medicaid work requirements to a lawsuit arguing the Affordable Care Act is unconstitutional.

Medicaid work requirements

U.S. District Judge James Boasberg of the District of Columbia, an appointee of former President Obama, ruled against the Trump administration on Wednesday for approving work requirements on Medicaid programs in Arkansas and Kentucky. The Department of Health and Human Services said it’s weighing whether to appeal the ruling.

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The National Health Law Program, which brought the lawsuits against Arkansas and Kentucky, also filed suit this month against work requirements in New Hampshire that are slated to take effect in the summer.

That case also could be heard by Boasberg, who ruled against the Kentucky program once before, in 2018. The administration reapproved the state’s initiative with a few changes, and it ended up back in court this year.

Boasberg said in his most recent ruling that the administration did not consider whether the state programs would meet what he called the core objective of Medicaid: to provide medical care to the needy.

More than 18,000 people have lost coverage in Arkansas since the requirements were implemented last summer. Kentucky’s program has not yet taken effect.

The administration began making a push for Medicaid work requirements in 2017 and has approved projects in nine states since then.

After New Hampshire's, Indiana's work requirements are next in line to take effect, meaning they’re likely to face a legal challenge.

Contraception mandate

The administration is facing lawsuits for issuing a rule that lets employers opt out of providing contraception in insurance plans if they have religious or moral objections.

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A federal judge granted a nationwide injunction in January in a lawsuit brought by attorneys general in Pennsylvania and New Jersey. A coalition of 13 states, led by California, also secured an injunction that month.

Both cases remain in litigation.

The contraception mandate has been mired in controversy and lawsuits since it was passed in 2011.

The Trump administration argues the mandate puts a "substantial burden" on employers with religious objections to contraception. Opponents of the exemption say it allows employers to interfere in the health care decisions of employees.

Association health plans

U.S. District Judge John Bates of D.C., an appointee of former President George W. Bush, on Thursday blocked the administration’s expansion of association health plans (AHPs) which it considers to be more affordable alternatives to ObamaCare plans sold on HealthCare.gov and state marketplaces.

The administration made a push for these plans after Congress failed to repeal and replace ObamaCare in 2017. A rule issued by the administration last summer allowed small businesses and other groups to band together to buy health insurance, but they don’t have to follow all of ObamaCare’s coverage requirements for areas such as maternity care and prescription drugs.

"Indeed, as the President directed, and the Secretary of Labor confirmed, the Final Rule was designed to expand access to AHPs in order to avoid the most stringent requirements of the ACA," Bates wrote in his opinion, adding that the plans are "clearly an end-run" around ObamaCare.

The lawsuit was filed last year by a coalition of 12 states, led by New York and Massachusetts.

The Department of Justice (DOJ) indicated it might pursue an appeal.

"We disagree with the district court’s ruling and are considering all available options," said DOJ spokeswoman Kelly Laco. "The Administration will continue to fight for sole proprietors and small businesses so that they can have the freedom to band together to obtain more affordable, quality healthcare coverage."

Short-term health plans

Oral arguments are expected in the coming months in a case challenging the Trump administration’s approval of short-term health plans, which are cheaper than ObamaCare plans but cover fewer benefits and don’t include protections for people with pre-existing conditions, meaning someone with cancer could be rejected for coverage.

Trump officials characterize the plans as an off-ramp for those who can’t afford ObamaCare’s more comprehensive plans. The administration issued a rule last year expanding the duration of the short-term plans to three years, well beyond their previous three-month limit.

A coalition of health groups sued last year, arguing that the plans undercut those that comply with ObamaCare’s requirements. As a result, they argue, ObamaCare-compliant plans will become more expensive as healthy, young people flock to short-term plans to save money.

ObamaCare

The DOJ sent shock waves through Washington when it said in a court filing this past week that it agreed with a lower court's ruling that ObamaCare is unconstitutional and should be nullified.

A coalition of Republican states, led by Texas, argues that because Congress in 2017 repealed the fine for not having insurance, ObamaCare is no longer valid.

Initially, the DOJ said only the provisions protecting people with pre-existing conditions should be struck down. But after a federal judge in Texas ruled in December that the whole law is unconstitutional, the DOJ said it agreed.

A coalition of Democratic states, led by California, is now filing an appeal in the 5th Circuit, where appeals court judges will hear the case. ObamaCare remains in effect while the case is being appealed.

That appeals process could last into mid-2020, with many legal analysts saying the case may end up before the Supreme Court.