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The decision by a federal judge in Texas to strike down all of the Affordable Care Act has thrust the volatile debate over health care onto center stage in a newly divided capital, imperiling the insurance coverage of millions of Americans while delivering a possible policy opening to Democrats. After campaigning vigorously on a pledge to protect patients with pre-existing medical conditions — a promise that helped return them to the House majority they had lost in 2010 — Democrats vowed to move swiftly to defend the law and to safeguard its protections. (Stolberg, Pear and Goodnough, 12/15)

Republicans, still stinging from their loss of the House in the midterm elections, are facing a fresh political quandary after U.S. District Judge Reed O'Connor said the entire 2010 health law was invalid. Warnings about the Texas lawsuit were part of the political narrative behind Democrats' electoral gains. Health care was the top issue for about one-fourth of voters in the November election, ahead of immigration and jobs and the economy, according to VoteCast, a nationwide survey for The Associated Press. Those most concerned with health care supported Democrats overwhelmingly. (Alonso-Zaldivar, 12/14)

Republicans are under greater pressure to produce an alternative to the law they have ardently opposed since its passage and a means to ensuring affordable health care coverage to some 52 million people with conditions such as diabetes, asthma and cancer. But they are still riven by the divisions that thwarted previous efforts to overhaul the law. (Sullivan, 12/15)

Republicans on Sunday said they wanted to maintain the 2010 law’s guarantee of insurance coverage for people with pre-existing conditions. But they also said they continued to oppose most or all of the law, such as its requirement that most people obtain health insurance, the so-called individual mandate. How they might accomplish both goals remained unclear. “There is widespread support for protecting people with pre-existing conditions. There’s also widespread opposition to the individual mandate,’’ said Sen. Susan Collins (R., Maine), speaking on CNN. She said the insurance-purchasing requirement, which is intended to ensure enough healthy people buy policies to make the plans economically viable, was particularly burdensome for low- and middle-income families. (Armour and Peterson, 12/16)

The result is likely to be a split GOP caucus that draws flak from both the right and the left. Republicans who survived the midterm elections by vowing to protect people with pre-existing conditions will find themselves in a particularly tough spot, feeling intense pressure to make good on that pledge. “It’s all the downsides,” a House GOP aide said. “Politically, I don’t think that it helps us at all.” (Demoko and Cancryn, 12/15)

“I’m not sure Republicans even know what they’re fighting for right now when it comes to health care,” said David Jolly, a former Republican congressman from Florida who now identifies as an independent. “Opposing Obamacare has become reflexive GOP orthodoxy, but they just spent six months saying they’d protect pre-existing conditions. Hard to square GOP campaign promises with the court victory by GOP attorneys general.” (Kapur, 12/15)

One day after a federal judge in Texas issued a decision in which he deemed the Affordable Care Act unconstitutional, a key Tennessee lawmaker expressed skepticism that the nation's high court would concur. In a statement issued Saturday, Sen. Lamar Alexander, who is chairman of the Senate Health Committee, said, "If the U.S. Supreme Court eventually were to agree that Obamacare is unconstitutional — which seems unlikely, however poorly the law was written — I am confident that any new federal law replacing it will continue to protect Americans with pre-existing conditions who buy health insurance." (Ebert, 12/16)

President Donald Trump on Saturday hailed a court decision against Obamacare as "a great ruling for our country," while a U.S. government official said the decision by a Texas judge would have no immediate impact on health coverage. (12/15)

"Mitch and Nancy, get it done!” Trump added, referring to Senate Majority Leader Mitch McConnell (R-Ky.) and expected incoming House Speaker Nancy Pelosi (D-Calif.). (Axelrod, 12/14)