Despite attempts from his allies to reportedly stop him from striking down a landmark healthcare law that has helped insure millions of Americans, Donald Trump is pressing forward with plans to gut the Affordable Care Act, as millions of people are facing the loss of their care amid a public health emergency during the coronavirus pandemic.
The president has previously claimed the administration has developed a plan of its own to help insure people who rely on healthcare plans through the ACA to continue their coverage — but over the last three years of his presidency, no such plan has been surfaced.
Meanwhile, states are prepared to make steep cuts to Medicaid as enrolment numbers surge in the wake of mass layoffs, adding to a growing rate of newly uninsured Americans.
Before a Wednesday deadline approached to make any last-minute changes to the administration's challenge to the law in the US Supreme Court in the fall, Attorney General William Barr tried to convince the president to limit its scope and keep some parts of the law intact, CNN had reported.
But the president appears ready to "terminate" the entire law, he said on Wednesday, despite pleas from officials in his own administration, fearing disastrous political fallout that could risk his re-election.
The law is a recurring target in his stump speeches and other events where he has promised to gut the legislation, while also promising to keep pre-existing condition protections intact.
Passed in 2010 under then-President Barack Obama, the ACA sought to bridge gaps in health coverage by offering plan subsidies and extending Medicaid to low-income Americans that previously were not covered under the state-administered programme.
Following its passage, the number of uninsured Americans decreased from more than 46 million in 2010 to less than 27 million in 2016, according to the Kaiser Family Foundation. The rates of uninsured Americans began to dip from more than 17 per cent before the law's passage to 10 per cent in 2016.
But under the Trump administration, which lifted individual mandate element of the law, the number of uninsured Americans has climbed or stalled out.
This week, he called it both a "disaster" and said "we've run it very well", while also claiming he "already pretty much killed it because we got rid of the individual mandate"
"We're replacing it with a great health care at far less money and it includes pre-existing conditions," he said.
The president also has repeatedly insisted that people with pre-existing conditions will continue to be covered if his administration successful dismantles the ACA -- but striking down the law without other measures in place would eliminate those protections for millions of people.
More than 11.4 million signed up for coverage through the ACA in 2020. Another 12.5 million people were enrolled through the Medicaid expansion.
With unprecedented unemployment claims, nearly 13 million people have likely lost their employed-provided plans since the onset of the outbreak, according to the Economic Policy Institute.
The president has also rejected a push for a special enrolment period to allow people to access the federal health insurance marketplace during the pandemic, though some states with their own state-administered marketplace have re-opened their programmes.
Several state officials, meanwhile, are proposing steep cuts to Medicaid, as millions of laid-off or out-of-work Americans look to enrol into the state-run health plan for lower-income Americans.
More than 70 million people rely on the programme for health coverage.
But with a decimated tax base and no revenue coming in during the crisis, and more people enrolled thanks to the ACA's Medicaid expansion, states are prepared to slash their Medicaid budgets and turning to Congress for a bailout.
Congress, meanwhile, has launched a defence of the ACA to the Supreme Court, stressing that healthcare access is a "life-or-death matter for millions of Americans", attorneys wrote in briefs this week.
The Covid-19 pandemic has created an "indispensable precondition to the social intercourse on which our security, welfare and liberty ultimately depend," they wrote.
California and more than a dozen other states also wrote to the nation's high court to defend the law.