The midterm elections will be held on November 6, 2018, and the Affordable Care Act (ACA) will surely be a hot topic on campaign trails. Republicans are expected to continue down a path of conveying their belief that the ACA is ineffective and has driven up healthcare costs. Democrats are expected to point out consumer protections that are included in the ACA, such as coverage for pre-existing conditions and essential health benefits. There are also three important lawsuits to watch which may shape the direction of the ACA regardless of the election outcome.

1. A coalition of 20 states, led by Texas, has filed a lawsuit contesting that the ACA is not constitutional when considering recent changes to the law. The Tax Cuts and Jobs Act zeroed out the Individual Mandate penalty starting in 2019. The requirement to have health insurance still exists under the ACA, but there is no penalty for being uninsured. In 2012, the Supreme Court Justices upheld the constitutionality of the Individual Mandate. Some of the Justices indicated the Individual Mandate was permissible because it was a tax. Now that there is no penalty, some Republicans argue that the ACA must go.

2. The cities of Baltimore, Chicago, Cincinnati and Columbus, OH have filed a complaint against President Donald Trump’s administration. These cities allege that the Trump administration is not upholding their constitutional responsibilities. They argue that the Trump administration is intentionally trying to sabotage the ACA when the Constitution requires the President and his administration to faithfully execute all existing laws.

3. A dozen state attorneys general are suing the Department of Labor (DOL) over the expansion of association health plans (AHPs). The DOL recently issued rules which provide more flexibility for small businesses to join forces when purchasing health insurance coverage. The new rules do not require AHPs to cover essential health benefits, a protection which otherwise applies to small group health plans. The state attorneys general believe this type of change requires Congressional approval and exceeds the regulatory power of the DOL. Furthermore, they argue this rule was issued to intentionally avoid certain requirements and protections that the ACA has in place for small businesses.

It's unclear how each of these lawsuits will play out, but you can expect many Republicans and Democrats to pick sides as these cases progress. It's hard to believe that it has been 8 ½ years since the ACA became law, and not a day goes by without something ACA-related making the headlines.

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