Opinion writer

In case you thought the Trump administration wasn’t determined to make health care, perhaps its worst issue, central to the 2020 campaign, think again:

Taking a harder line on health care, the Trump administration joined a coalition of Republican-led states Wednesday in asking a federal appeals court to entirely overturn former President Barack Obama’s signature health care law — a decision that could leave millions uninsured.

Congress rendered the Affordable Care Act completely unconstitutional in 2017 by eliminating an unpopular tax penalty for not having insurance, the administration and GOP states told the court.

The “Obamacare” opponents hope to persuade the 5th U.S. Circuit Court of Appeals in New Orleans to uphold U.S. District Court Judge Reed O’Connor’s ruling late last year striking down the law.

The administration had already made its support for this substantively catastrophic and politically suicidal lawsuit clear, but this was the administration’s formal filing in support of it. If the Republican position were to be upheld, 20 million or so Americans would lose their health coverage, over 50 million would lose protections for their preexisting conditions, and insurers would be able once again to charge women more than men, impose yearly and lifetime limits, and rescind your coverage if you get sick or have an accident.

That’s just the beginning. The ACA has been woven so tightly into America’s health-care system that eliminating it in one fell swoop would be the most cataclysmic upheaval the system has ever experienced.

Which means that Democrats have a powerful (and completely accurate) argument to make in 2020: If President Trump is reelected, he’s coming for your health security.

You’ve probably forgotten that a little over a month ago, Trump promised that Republicans were about to come up with a health-care plan that would be “spectacular.” Then just days later, he decided that they wouldn’t actually be doing that, and all that spectacularness would have to wait until after the 2020 election. They can’t produce a plan, because they know that one that actually embodies conservative principles would be politically disastrous. So they have to just keep putting it off.

Next year, each side is going to say essentially two things on health care: what's wrong with the other side and what they want to do.

Democrats will say that Trump is trying to take away the ACA, and they want to expand coverage and protections. In what way will depend on who the presidential nominee is; it might be some vague "strengthen the ACA” message if the nominee is someone like Joe Biden, or it might be Medicare-for-all in some form if it’s one of the other candidates.

Trump, on the other hand, will say that Democrats want a socialist nightmare in which everyone will die in the gutter and the closest thing you’ll get to health care is a raccoon gnawing on your bones, while he wants a “spectacular” plan that will do all the good things the ACA does, but which he’s not actually going to specify.

To see who's likely to get the better of that argument, you only have to look at the 2018 election, when the administration's position on the ACA turned out to be the most extraordinary political gift Democrats could hope for.

Health care is an issue that touches all of our lives, and voters are already predisposed to distrust Republicans on it. When Republicans are taking the position that they want to snatch coverage away from tens of millions and take away preexisting-condition protections from tens of millions more, they’ve done Democrats’ work for them. While Republican candidates tried to trot out some “Democrats are threatening your Medicare!” arguments to contain the damage last November, it didn’t work.

So why on earth are Republicans still pushing this lawsuit? The simplest explanation is that they trapped themselves and now they can’t turn back. They spent years saying they wanted to repeal the ACA, and when a bunch of radical conservatives in state government filed the suit, they got on board. Abandoning it now would look weak and could anger the party’s base, who are the only voters Trump cares about.

I have predicted that when this case reaches the Supreme Court, Chief Justice John G. Roberts Jr. is going to side with the liberals and rule against the administration precisely because he’s a loyal Republican, albeit one who’s smart enough to know when his party needs to be saved from itself. While it might be bad for Republicans to have health care be an active issue in 2020, nothing could be worse for them than if they actually succeeded. But that won’t be enough to keep them from paying a very large price.

Read more:

Paul Waldman: Trump just realized his mistake on health care. But it’s too late.

Jennifer Rubin: Just how big is Trump’s health-care mistake?

Ezekiel Emanuel: The big secret about the Affordable Care Act: It’s working just fine

James Downie: Republicans’ missing health-care plan

Catherine Rampell: If the GOP built their ideal health-care system . . . it’d be Obamacare