By AL CROSS

Kentucky Health News

FRANKFORT — A federal judge in Texas has ruled the Patient Protection and Affordable Care Act unconstitutional, making likely that the U.S. Supreme Court will get its third chance to strike down the 2010 law widely known as Obamacare.

The ruling sparked sharp objections from supporters of the law, including Kentucky Attorney General Andy Beshear, who said on Twitter Saturday, “I will lead the fight to overturn Friday night’s ruling from Texas that could eliminate health care coverage for more than 1.3 million Kentuckians and which would cost our state more than $50 billion” in federal health-insurance payments over 10 years.

At a news conference Monday, Beshear declined to repeat his assertion that he would “lead the fight.” He is among 16 Democratic attorneys general who intervened to defend the law after the U.S. Justice Department did not.

“It’s fair to say there has been more than one leader, but we have been as active as any other state and will continued to be that active,” Beshear said. Later, he said he would be “as vocal if not more vocal” than the others, and that potential impacts on Kentucky, “given the health of our people, I believe is more stark than just about any other state.”

“The ruling would devastate Kentucky,” Beshear said. “It would devastate our families, and I will not let it stand.” He listed 10 harms, including coverage for pre-existing conditions, which about half of Kentuckians have “”everything from asthma to acne”); repeal of the Medicaid expansion, which has covered almost half a million Kentuckians; increased financial threats to rural hospitals; and re-creation of the “donut hole” for prescription drugs in Medicare.

U.S. District Judge Reed O’Connor of the Northern District of Texas ruled in a lawsuit by 18 Republican attorneys general, who argued that the law is unconstitutional because the 2017 tax cut passed by Congress repealed the tax penalty for not having health insurance, and the 2012 Supreme Court ruling upholding the law said the rule was a constitutional exercise of Congress’s taxing power.

Beshear said the ruling goes farther than even the Republican AGs wanted, in throwing out the whole law, and “I believe that most legal scholars will tell you that we’ll be able to get it overturned.”

Of the 16 Democratic attorneys general in the case, Beshear is the only one on the ballot in 2019, as a candidate in the May 21 primary for governor. Gov. Matt Bevin, a critic of the law and Beshear (the feelings are mutual), is likely to be the Republican nominee for governor. His predecessor, Democrat Steve Beshear, is the attorney general’s father and an outspoken advocate of the law — which he embraced by expanding the state Medicaid program under its provisions.

Asked if the other AGs would let him take the lead because he is on the ballot, Beshear said, “At the end of the day, this isn’t about any election. This is about future health-care coverage for 1.3 million Kentuckians.” Medicaid covers almost 1.4 million, but the law’s expansion of it covers only 450,000, and fewer than 100,000 Kentuckians are enrolled in insurance plans subsidized by the law.

Asked if most Kentuckians favor or oppose the law, Beshear said they favor the Medicaid expansion, covering people with pre-existing conditions and those who become sick, and not discriminating against women and seniors. “I believe that if Kentuckians understand what’s at stake,” he said, “they will most certainly be with us on this.”

Asked if the case gives him and other Kentucky Democrats a stronger talking point on an issue that was helpful to Democrats in other states in last month’s elections but not so much here, Beshear said, “I want to give Republicans the opportunity to be supportive of this.”

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.