A Texas court gives Democrats get another chance to campaign on health care

Illustration: Sarah Grillo/Axios

For the second election cycle in a row, a Republican-appointed federal judge in Texas has given Democrats an opening to campaign on saving the Affordable Care Act — an opportunity they relish.

Why it matters: Weaponizing the GOP's 2017 attempt to repeal and replace the ACA was hugely successful for Democrats in the 2018 midterms. Republicans have been eager to talk about anything but the ACA since then, but Judge Reed O'Connor has twice now issued decisions that put key tenets of the law at risk.

Driving the news: O'Connor yesterday ruled the federal government cannot require a Christian-owned company to cover HIV preventative medication because it violates their religious rights under federal law.

• He also found that the ACA's requirement that insurers cover care recommended by the U.S. Preventive Services Task Force is unconstitutional, although he upheld the law's requirement about the recommendations of two other agencies.
• "If today's ruling stands, colonoscopies, Pap smears, PrEP, and a broad range of preventive pregnancy-related services may no longer be covered w/o cost sharing," KFF's Alina Salganicoff tweeted.

Flashback: O'Connor is the same judge that sided with GOP state attorneys general in a case that argued the ACA is unconstitutional and should be struck down.

• The case went to the Supreme Court, which heard arguments in 2020 but ultimately upheld the law.

What they're saying: "This extreme MAGA ruling comes just months after the Republican-controlled Supreme Court discarded precedent and privacy in overturning Roe v. Wade," House Speaker Nancy Pelosi said in a statement hours after the decision was released.

• "As extreme MAGA Republicans work to rip away life-saving drugs, Democrats are fiercely defending health freedom, protecting access to health care and lowering the cost of prescription drugs," she added.

Be smart: The Supreme Court's decision to overturn the federal right to abortion this summer arguably gave Democrats their most effective campaign message of the cycle, ahead of what was expected to be a red wave this fall.

• If Pelosi's statement is any indication, the party will eagerly tie that decision to yesterday's and make November's election even more about health care.

Between the lines: Democrats have been trying to make the case that Republicans support undoing popular health care policies — like their recently-passed prescription drug law that allows Medicare to negotiate directly with manufacturers — in addition to highlighting the party's support for abortion bans.

• "Don't get it twisted: the GOP does have a health care agenda, and it includes cutting Social Security and Medicare and banning abortion with no exceptions for rape or incest," the DNC wrote in an email earlier this week.
• But Democrats' case that the GOP will try again to repeal and replace the ACA or to repeal the drug law hasn't been particularly convincing, and has been based mostly on stray comments from not-particularly-relevant lawmakers.
• In reality, vulnerable Republicans have mostly been silent on health care.

What we're watching: O'Connor has yet to say how broadly the decision applies, and the preventive services requirements are still in place for now. He's asked both parties to submit proposals for the "scope of the relief," or the implementation of the decision.

• And even if he ends up blocking the enforcement of those requirements, the decision will almost certainly get appealed.

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