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Federal Judge In Texas To Hear States' Case Against Obamacare

STEVE INSKEEP, HOST:

Tomorrow, a judge in Texas hears a request to suspend the Affordable Care Act nationwide. Blake Farmer of WPLN met a woman with a stake in the outcome.

BLAKE FARMER, BYLINE: Jenny Rogers frets about the fate of the Affordable Care Act more than most in rural East Tennessee.

JENNY ROGERS: My husband and I own and operate a log cabin lodging business on the Ocoee River.

FARMER: Not only is Rogers on her own for buying health insurance, but with chronic bladder and stomach ailments, she has a pre-existing condition. And before the ACA, she says her policy sometimes jumped 30 percent a year.

ROGERS: And we were, you know, hanging on by a thread. And then when it went up to $1,900 a month, we just couldn't do it.

FARMER: Rogers decided to go without coverage. Then, Democrats squeezed through President Obama's overhaul, barring insurance companies from pricing plans based on health history. Rogers and her husband were able to get more affordable coverage on the individual marketplace. She says if that protection goes away, she and millions of others would face the same costly predicament.

ROGERS: Almost everyone has a pre-existing condition by the time they're in their 50s.

FARMER: Along the mountainous border with Virginia, northeast Tennessee has the highest rate of pre-existing conditions in the country according to a new analysis from the Kaiser Family Foundation. That's where Dr. Eric Harman has spent his career treating patients with diabetes, hypertension, obesity and even drug abuse. This region stands to benefit more than almost anywhere else. But Harman says the health care law remains a whipping post here.

ERIC HARMAN: You know, Obamacare is a word that gets people riled up, you know? And I don't really - I don't know if I totally understand that.

FARMER: Motivated by that popular disdain, 20 Republican attorneys general, led by Texas, sued earlier this year. Here's the gist of the legal argument. Since Congress effectively took away the mandate that everyone buy insurance and since Democrats argued the law only worked with that individual mandate, the entire law is invalid. Some scholars are calling the logic ludicrous. But health care attorney Amy Sanders Morgan of Bass, Berry & Sims says people laughed off the last challenge, too.

AMY SANDERS MORGAN: That kind of started out as a very small case that no one really took all that seriously. And it made its way all the way up to the Supreme Court and became a formidable challenge.

FARMER: And in this case, the challengers have an advantage no one saw coming. The Trump administration chose not to even defend the law.

XAVIER BECERRA: Quite honestly, the federal government went AWOL.

FARMER: Xavier Becerra is California's attorney general and is taking the unusual move of intervening to defend the ACA in court. He says striking it down would have far-reaching effects. Aside from pre-existing conditions, the law also helps families keep their children on a health plan after college, there are drug benefits for seniors, and Medicaid expansion could go away.

BECERRA: We would throw the health care system into chaos.

FARMER: Even Republicans aren't hyping the case. Governor Bill Haslam of Tennessee, one of the 20 states involved, says reversing popular provisions would be painful.

BILL HASLAM: Any time you take away any kind of benefit, that is politically tricky at best if not a real death wish politically.

FARMER: Still, Haslam supports his attorney general trying to dismantle the law, saying the ACA took the easy way out in not controlling health care costs. Costs are also on Dr. Harman's mind in northeast Tennessee, though. All those patients with chronic conditions who flooded his office, newly covered by the ACA, will now likely show up in emergency rooms, uninsured.

HARMAN: An ER visit is, like, 10 times as expensive as a visit in my office. And I think, as a country, we're short-sighted.

FARMER: Harman says, one way or another, American taxpayers will get the bill.

For NPR News, I'm Blake Farmer in Nashville.

(SOUNDBITE OF TOE'S "DUAL HARMONICS")

INSKEEP: That story comes out of a reporting partnership between NPR, WPLN and Kaiser Health News. Transcript provided by NPR, Copyright NPR.

Blake Farmer