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More than 1,000 miles from the caustic Supreme Court confirmation hearing of Brett M. Kavanaugh, a federal judge in Texas on Wednesday listened to arguments about whether to find part or all of the Affordable Care Act unconstitutional, in a case that may end up before a newly right-leaning set of justices. The case has become not simply a threat to the landmark legislation. Democrats have sought to make it both a flash point in the battle over whether to confirm Judge Kavanaugh and a crucial prong in their strategy to retake control of the House and Senate in the midterm elections. (Goodnough, 9/5)

The latest push to scrap the Affordable Care Act once and for all pressed ahead Wednesday as Republican-controlled states asked a federal judge to finish what Congress started last year and bring the law that insures 20 million Americans to a halt. A small group of protesters, some holding signs reading "Save the ACA," shouted across the street from a Fort Worth, Texas, courthouse where former President Barack Obama's health care law is again under attack. At issue are core principles of the law, including protections for people with pre-existing medical conditions and limits on how much older customers can be charged. (Weber, 9/5)

The nearly four hours of legal sparring at Wednesday’s hearing shone a light on the partisan acrimony surrounding the statute that, several years after it extended health coverage to millions of Americans, remains a favorite Republican whipping post and is serving as a convenient rallying cry for Democratic candidates in this year’s midterm elections. In an abnormal arrangement, attorneys for the federal government — the defendant in the case — sat on the same side of the courtroom as the plaintiff’s lawyers during Wednesday’s hearing. The odd seating pattern stems from the fact that the Trump administration is largely agreeing with the plaintiffs who are suing. In June, the Justice Department saying in a court filing it would not defend the law. (Goldstein and Reaves, 9/5)

At the hearing Wednesday, Texas aimed to convince U.S. District Judge Reed O’Connor to block the law across the country as it continues to fight a months- or years-long legal case that could land before the U.S. Supreme Court. Citing rising health care premiums, Texas says such an injunction is necessary to preserve state sovereignty and to relieve the burden on residents forced to purchase expensive insurance coverage. California counters that temporarily blocking or ending the law would cause more harm to the millions of people insured under it, particularly the 133 million people the state says enjoy the law’s protections for pre-existing conditions. The U.S. Department of Justice, which has taken up many of Texas’ positions in the case, nonetheless sided with California, arguing that an immediate injunction would throw the health care system into chaos. (Platoff, 9/5)

Democrats warned that a popular provision in the ACA requiring insurers to cover people with pre-existing health conditions –which includes a wide range of ailments, from sleep apnea to cancer – is in danger of disappearing. (Radelat, 9/5)

O'Connor, in his questions from the bench, cut straight to the so-called severability in the case—whether Congress, when it zeroed out the tax penalty in the 2017 tax overhaul, intended to keep the popular consumer protections in place. "It does seem for the majority of cases, the Supreme Court says to look at the original legislation as enacted," O'Connor said. "Why would I not? Let's assume I don't buy the argument it is still a tax and believe the mandate should fall and I get to severability, why wouldn't I look at those cases?" (Luthi, 9/5)

Judge O’Connor, who was appointed by former President George W. Bush, said he would issue a decision as quickly as he can. If he strikes down the ACA or parts of it, the 16 Democratic attorneys general who intervened in the case would likely seek a stay of the decision as they file an appeal. The case could wind up in the Supreme Court. Attorneys representing the Democrats said millions of people with pre-existing conditions could be harmed if the ACA is tossed. “The harm of striking down the ACA…would be devastating,” said Nimrod Elias, a California deputy attorney general. (Hobbs and Armour, 9/5)

“If necessary we're ready to go to the appellate court,” a spokesperson for the California Department of Justice, which defended the health law in court, told The Hill on Wednesday. (Sullivan, 9/5)

Democrats have pointed to the administration’s decision not to defend the law in court, attacking Republicans for seeking to overturn the protections, which are some of the most popular parts of the law. “All we really need is about another two months because I believe that the best way to guarantee that we strengthen the health care law and protect pre-existing conditions — to change the law you change the lawmakers,” said Rep. Lloyd Doggett, D-Texas, at a press conference Wednesday.  (McIntire, 9/5)

The Trump administration isn’t defending Obamacare from a legal attack that could finally slay the embattled health-care law, but the federal government cautioned Wednesday that an immediate and nationwide halt may trigger “chaos.” Unlike the state of Texas, which urged a federal judge to block the Affordable Care Act right away, the Justice Department wants a court order not to take effect before Jan. 1, when the provision requiring people to pay a tax if they don’t have insurance is phased out. (Korosec, 9/5)

Kaiser Health News: LISTEN: The GOP Case Against ACA’s Preexisting Condition Protections Begins 

Ashley Lopez of member station KUT in Austin reports on the first day in court, and KHN’s Senior Washington Correspondent Julie Rovner discusses what it all means on NPR’s All Things Considered. (9/6)

Senate Majority Leader Mitch McConnell (R-Ky.) signaled to reporters on Wednesday that he doesn’t have any plans to move again this year to repeal ObamaCare, even though Republicans might now have a better chance of success after Sen. Jon Kyl (R-Ariz.) was sworn in. Senate Republicans view Kyl as someone more likely to vote with GOP leaders on health care reform legislation than was late Sen. John McCain (R-Ariz.), the maverick whom Kyl replaced after his death. (Bolton, 9/5)

Several health insurers have sued the U.S. government over its failure to make cost-sharing reduction payments that help lower healthcare costs for certain consumers. One just scored the first victory. The U.S. Court of Federal Claims ruled in favor of Montana Health Co-op, which sued the federal government for $5.3 million in unpaid cost-sharing reduction payments, finding that the government violated its obligation under the Affordable Care Act when it stopped paying the CSRs in October 2017. (Livingston, 9/5)

Connecticut insurance customers and health care advocates on Wednesday urged state regulators to reject proposals to raise rates next year. Those calls surfaced during a Connecticut Insurance Department hearing focused onAnthem Blue Cross and Blue Shield and ConnectiCare Benefits Inc.’s proposed increases for individual plans. (Silber, 9/5)

Democratic attorney general candidate Steve Dettelbach on Wednesday called out two Republican candidates for statewide office over their past opposition to the Affordable Care Act. After several legal challenges and scores of unsuccessful votes in Congress, arguments began in Texas Wednesday in a suit brought by 20 Republican attorneys general seeking to gut the ACA for good. (Schladen, 9/5)