On November 11, a group of twenty state attorneys general, backed by the Trump administration, will try to argue in front of the Supreme Court that the Affordable Care Act’s (ACA) individual mandate is unconstitutional and therefore the entire law should be invalidated.

Doing so would put health insurance subsidies, anti-discriminination and pre-existing condition protections, and Medicaid expansion in immediate jeopardy. All told, it could strip health coverage from roughly twenty-three million people—disproportionately hurting low-income families and communities of color. Millions more could lose access to consumer protections in the law, and the gains made in closing racial disparities in coverage and access to care could be reversed. As a part of the fallout, as many as 135 million Americans with pre-existing conditions could be charged more or denied coverage altogether.

Opponents of the ACA have spent years trying to repeal or hobble the ACA. The GOP-led Congress alone has voted more than sixty times to dismantle parts of the health care law. The timeline below aggregates the many legislative, regulatory, and legal efforts that GOP lawmakers and the Trump administration have taken in order to specifically strip protections for pre-existing conditions.

Annie L. Mach and Janet Kinzer, “Legislative Actions to Modify the Affordable Care Act in the 111th-115th Congresses,” Congressional Research Service, 2018, https://fas.org/sgp/crs/misc/R45244.pdf.
Ed O’Keefe, “The House has voted 54 times in four years on Obamacare. Here’s the full list.” Washington Post, 2014, https://www.washingtonpost.com/news/the-fix/wp/2014/03/21/the-house-has-voted-54-times-in-four-years-on-obamacare-heres-the-full-list/.
C. Stephen Redhead and Janet Kinzer, “Legislative Actions in the 112th, 113th, and 114th Congresses to Repeal, Defund, or Delay the Affordable Care Act,” Congressional Research Service, 2017, https://fas.org/sgp/crs/misc/R43289.pdf.
“Sabotage Watch: Tracking Efforts to Undermine the ACA,” Center on Budget and Policy Priorities, last updated July 22, 2020, https://www.cbpp.org/sabotage-watch-tracking-efforts-to-undermine-the-aca.
Julie Rovner, “Timeline: Despite GOP’s Failure To Repeal Obamacare, The ACA Has Changed,” Kaiser Health News, 2018, https://khn.org/news/timeline-roadblocks-to-affordable-care-act-enrollment/.
Abbe R. Gluck, Mark Regan, and Erica Turret, “The Affordable Care Act’s Litigation Decade,” The Georgetown Law Journal, 108:1471 (2020), https://www.law.georgetown.edu/georgetown-law-journal/wp-content/uploads/sites/26/2020/06/Gluck-Reagan-Turret_The-Affordable-Care-Act%E2%80%99s-Litigation-Decade.pdf.