The Affordable Care Act is under fire again in federal court

The fate of the Affordable Care Act played out anew Wednesday as a score of Republican-led states sought to persuade a federal judge in Fort Worth to halt the health-care law.

In the latest threat to the ACA, the coalition of GOP attorneys general and governors argued that a change in federal tax policy made the law unconstitutional, and they requested a preliminary injunction that would suspend the statute while the rest of the case unfolds – a ruling that would throw the U.S. health-care system into chaos.

U.S. District Judge Reed O'Connor, a conservative jurist appointed by President George W. Bush, did not immediately rule or indicate when he would do so. He asked more pointed questions of the parties arguing in favor of the ACA, while asking the opponents about the impact of a preliminary injunction or an outright ruling against the law.

The hearing, part of a lawsuit filed in January by the Texas attorney general and his allies, drew heightened attention for its timing amid the contentious Senate confirmation hearing for Brett Kavanaugh, President Donald Trump's Supreme Court nominee. Advocates on both sides predict O'Connor's eventual ruling will be appealed and could become the first ACA case to reach the high court with Kavanaugh as a member.

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 – a nod to their unwillingness to defend the law.

A group of Democratic attorneys general, who have won standing in the case, were left to argue Wednesday for the law's preservation.

The ACA has been upheld twice by the Supreme Court. In a 2012 ruling in a case challenging the law's requirement that most Americans buy health insurance, the majority reasoned that Congress' authority to set taxes made that mandate constitutional. The law contains a tax penalty for people who flout the requirement.

In an argument that several legal scholars regard as weak, Texas Attorney General Ken Paxton, R, and his allies say that the high court's opinion is out of date because late last year, Congress passed a law that ended the individual mandate penalty.

At the hearing, Darren McCarty, an assistant Texas attorney general, argued that once the penalty is removed, "the entire ACA falls."

The Justice Department agreed that without the mandate, required benefits and consumer protections will not be valid, including the highly popular preexisting conditions protection. But it also said many other aspects of the law can survive because they can be considered legally distinct from the insurance mandate and consumer protections.

Notably, Brett Shumate, a deputy assistant attorney general arguing for the Trump administration, asked the judge not to grant a preliminary injunction – at least not soon – saying that it would "cause chaos in the insurance markets." The next yearly shopping period for health plans through ACA insurance marketplaces is scheduled to start in November. The administration would prefer that the judge simply rule on the case after giving the parties more time to present evidence, Shumate said.

Arguing on behalf of the Democratic states, a pair of California deputy attorneys general told the judge the proper legal path was to strike down Congress's removal of the penalty – not to rule against the law.

One of them, Neli Palma, said that a preliminary injunction would cause "profound harm to the public interest" and millions of Americans. Such an injunction, she said, "is meant to maintain a status quo. They are seeking to blow it up."

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Gayle Reaves reported from Fort Worth.