With Republicans in control ofthe executive and legislative branches, Democratic attorneysgeneral are seen as a check on Trump administration policies.(Photo: Shutterstock)

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For years, congressional Republicans have vowed to repeal the Affordable Care Act. Now,in a case sending shock waves through midterm election campaigns, Republicanattorneys general across the country may be poised to make good onthat promise.

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The case, Texas v. United States, reveals just how highthe stakes are for health care in this year's attorney generalraces, elections that rarely receive much attention but have thepower to reverberate through the lives of Americans.

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Trumpcare The dismantling of
the ACA: A timeline

A look at the key
developments and changes to
the landmark health
care law over the past year.

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“It just shows that nothing is safe,” said Xavier Becerra,California's attorney general, who is leading 16 states and theDistrict of Columbia in defending the ACA in the case.

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Both parties expect record-breaking fundraising for this year's30 contested elections for state attorneys general. Democrats aimto translate public outrage over the threat to the ACA into thevotes needed to seize a handful of posts currently held byRepublicans.

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This will be the first major election since Republicans tore up a deal brokered with Democrats roughly two decades agonot to challenge each other's incumbents in attorney general races.That gentlemen's agreement acknowledged the need for attorneysgeneral from both parties to collaborate on investigations andlawsuits.

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But some of the same partisan forces that have embitteredCapitol Hill have spilled into these contests. With Republicans incontrol of the executive and legislative branches — and close tostaking their claim on the Supreme Court — Democratic attorneysgeneral are seen as a check on Trump administration policies.Similarly, their Republican counterparts frequently took the Obamaadministration to court.

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That pressure is likely to increase should congressionalDemocrats fail to win control of at least one chamber of Congressin November.

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Raphael Sonenshein, the executive director of California StateUniversity's Pat Brown Institute for Public Affairs in Los Angeles,compared the politics invigorating state attorneys general to a barbrawl.

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“Two people have a fight, and then it spills out into thestreet, and 20 people join in,” he said. “Everybody gets off thebench and joins the fight.”

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A banner on the Democratic Attorneys General Association'swebsite captures theirmindset, while states are busy challenging the Trump administrationon issues like sanctuary cities and family separations at theborder: “This office has never been more important.”

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Former Vice President Joe Biden recently endorsed six attorney general candidates in racesDemocrats think they can win, including Ohio and Wisconsin, and theassociation plans to raise a record-breaking $15 million forNovember's elections, said Lizzie Ulmer, a spokeswoman for thegroup.

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By mid-June, the Republican Attorneys General Associationhad raised $26.6 million, continuing to break its fundraisingrecords.

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Of this year's 30 contested attorney general races, 18 posts areheld by Republicans and 12 are held by Democrats. (Another five arein play this year, but those posts are appointed by the governor orstate lawmakers.)

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Unlike in Congress, there is no inherent advantage to one partyclaiming the majority of attorneys general posts. It takes just oneattorney general to file a lawsuit.

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But Democratic attorneys general see themselves as a firewallagainst an administration and their Republican counterparts deadset on revoking many federal protections. In that arena, everylawyer counts.

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That is especially the case with health care, where fights overissues like access to abortion have multiplied since PresidentDonald Trump took office, with others liable to end up in thecourts at any time.

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Earlier this month, a federal judge heard arguments in Texas v.United States on the constitutionality of the individual mandate,the ACA's requirement that all Americans obtain health insurance orpay a penalty.

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Citing the law passed late last year that eliminated thepenalty, the plaintiffs — a Texas-led coalition of 20 states andtwo individuals — argued the individual mandate was nowunconstitutional. By extension, so was the rest of the ACA, theysaid. They asked for a preliminary injunction that could halt thesweeping ACA in its tracks — including popular provisions such asprotections for people with preexisting conditions.

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Ken Paxton, the attorney general of Texas, has defended hisdecision to challenge protections that have broad support,including among Republicans, saying he has a duty to fight lawsthat harm Texans and defy the U.S. Constitution.

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“The least compassionate thing we could do for those withpreexisting health problems is to take away their access tohigh-quality care from doctors of their own choosing and place thementirely at the mercy of the federal government,” Matt Welch,Paxton's campaign spokesman, said in a statement.

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But the idea that insurers would no longer have to cover thosewith preexisting conditions has proven explosive, offeringDemocrats a powerful rallying cry beyond even attorney generalraces. In Missouri and West Virginia, states that Trump won in 2016but are represented by Democratic senators, the issue has followed theRepublican attorneys general — Missouri's Josh Hawley and WestVirginia's Patrick Morrisey — as they run for Senate.

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“We're wasting millions and millions of dollars of taxpayermoney trying to take away preexisting condition protections notjust for all Texans but all Americans,” said Justin Nelson,Paxton's Democratic challenger, who said he would withdraw Texasfrom the case should he win his long-shot bid.

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In Wisconsin, the Republican attorney general, Brad Schimel, hasalso taken a leading role in Texas v. United States, as well as a2016 challenge to a landmark Obama administration rule banningdiscrimination in health care based on a patient's gender identity,among other cases.

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This year, Schimel has drawn a formidable Democratic challenger,Josh Kaul. He's a former assistant U.S. attorney who prosecutedfederal drug crimes and has promised to focus on the state'sbacklog of untested rape kits and take a more aggressive approachto the opioid epidemic. “We're not going to beat that withoutensuring our efforts are targeting large-scale drug traffickers,”he said.

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Experts caution a changing of the guard would not spell the endof a big case like Texas v. United States. For instance, even ifPaxton were to defy expectations and lose, Texas' legal andfinancial backing for the case could easily be picked up by anotherstate.

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However, the message voters would send by electing a Democraticattorney general in Texas — where no Democrat has won statewideoffice since 1994 — could have profound implications for Republicanmorale.

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“Without Ken Paxton leading the charge, many Republicans maysoften their opposition to Obamacare,” said Brandon Rottinghaus, apolitical science professor at the University of Houston.

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Kaiser Health News is anonprofit news service covering health issues. It is an editoriallyindependent program of the Kaiser Family Foundation, which is notaffiliated with Kaiser Permanente.

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