The fate of former President Barack Obama's signature health care law, and its coverage and insurance protections for millions of Americans, is again being argued before a panel of judges - this time a federal appeals court in New Orleans.
California and the 19 other states, as well as the District of Columbia, which won permission to defend the law when the Trump administration declined to do so, appealed to the federal court in New Orleans to reverse the Texas ruling.
"If they have their way, millions of Americans could be forced to delay, skip or forego potentially life-saving health care", he said.
Defenders of the law have expressed concerns recently that the 5th Circuit could throw out the case on procedural grounds after the appellate court asked the Democratic-led states and the House late last month to explain their legal standing in intervening and appealing the ruling. It held that if people had to pay a penalty for not buying insurance, that payment was effectively a tax. People are still required by law to purchase state subsidized health insurance, but there is no penalty for ignoring the law.
She signed up for a plan available to the self-employed on the federal health exchange - with better benefits at lower out-of-pocket costs - as soon as it became available following the 2010 passage of the ACA law under the Obama administration.
His 2012 rationale for upholding the ACA's individual insurance mandate was tied to Congress' taxing power.
The Fort Worth judge concluded in December that wiping out the penalty undermined the ACA's constitutional basis and invalidated the whole law.
"There's a political solution here that you, various parties, are asking this court to roll up its sleeves and get involved in", he told House General Counsel Douglas Letter. It voted to reduce the penalty to zero but not to eliminate the law entirely.
"This is a law touching almost every aspect of our health care system". They have tried to cut Medicare and Medicaid, privatize health care for veterans and remove the guardrails that protect consumers from insurance companies.
The Morning Consult poll also found that voters are increasingly placing responsibility for the state of the USA health care system on Trump - and half of voters say the system has gotten worse over the past decade.
Trump has repeatedly said he is working on a replacement plan that will preserve those protections but has yet to release any details.
A group of 17 blue states led by California who are defending the ACA argued at the hearing Tuesday that Congress' intent was clear when it made a decision to not get rid of the rest of the law. Still, Judge Kurt Engelhardt, a Trump appointee, pointed out that Congress could settle this dispute by cutting the individual mandate entirely, thereby eliminating the basis for the lawsuit altogether.
An audio recording of oral arguments in the case can be found here.
Republican opponents call the law an unwarranted intervention by government, while supporters say striking it down would threaten the health care of 20 million people who have gained insurance under the law.
Twelve million seniors who have saved millions of dollars on their prescription drugs under the ACA will no longer receive these savings.
People can get free birth control, mammograms, and cholesterol checks. And kids can stay on their parents' health insurance policy until they turn 26. While Cogan said he and many other experts in health care law think the GOP attorneys' arguments in this case are weak, the court's decision may not reflect that.