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The Trump administration formally declared its opposition to the entire Affordable Care Act on Wednesday, arguing in a federal appeals court filing that the signature Obama-era legislation was unconstitutional and should be struck down. Such a decision could end health insurance for some 21 million Americans and affect many millions more who benefit from the law’s protections for people with pre-existing medical conditions and required coverage for pregnancy, prescription drugs and mental health. (Hoffman and Goodnough, 5/1)

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. If the ruling is allowed to stand, more than 20 million Americans would be at risk of losing their health insurance, re-igniting a winning political issue for Democrats heading into the 2020 elections. President Donald Trump, who never produced a health insurance plan to replace "Obamacare," is now promising one after the elections. (McGill and Alonso-Zaldivar, 5/1)

At earlier stages of the case, the Trump-era Justice Department argued against several central provisions of the ACA, but it didn’t ask the court to strike down the whole law. The department signaled its change of heart in a one-paragraph letter submitted to the Fifth Circuit in March, but it didn’t lay out its new position at the time. “Once those core provisions are excised, the balance of the ACA cannot continue to operate as intended,” the Justice Department said in Wednesday’s filing. “Instead of rewriting the statute by picking and choosing which provisions to invalidate, the proper course is to strike it down in its entirety.” (Kendall and Armour, 5/1)

The Trump administration is soliciting new ideas to improve the 1332 waiver system that allows states to bypass parts of the Affordable Care Act, the latest move to get more states interested. The request for information issued Wednesday comes after the CMS and Treasury Department in October relaxed the process for states to get a waiver, which were created under the ACA to enable states to provide alternative coverage approaches. (King, 5/1)