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La. Attorney General Jeff Landry speaks during a groundbreaking ceremony for the expansion of the LHC Group home office campus Friday, March 22, 2019, in Lafayette, La.

If Louisiana Attorney General Jeff Landry, a bunch of other state-level Republicans — and as of this week, the Trump administration — get their way, a lot of Americans could lose their health coverage.

New numbers released this week put the number of Louisianans in that category at nearly 600,000. Just over a half million state residents now have insurance through the Affordable Care Act’s Medicaid expansion, and nearly 93,000 are covered through the law’s individual exchanges. Still more Louisianans could lose access to insurance they can afford despite having pre-existing conditions. Young adults could no longer be allowed onto their parents’ health plans. Lifetime coverage limits that can send families into bankruptcy could disappear. And so on.

Frankly, the benefits of the ACA, or Obamacare, are widely known by now, and are baked into the country’s health care system.

Obamacare enrollment in Louisiana falls to record low; 2 key reasons cited cited

And the furious public push-back against GOP efforts to repeal the law during the last Congress without offering a suitable replacement — and the Democrats’ success in capitalizing on the issue in the 2018 midterms — both point to a sea change in the politics over the matter. Obamacare can and should be improved, but at this point it’s clear that many of its provisions are immensely popular. The proof is in the Republicans’ inability to come up with an alternative they can sell.

Nor do the new numbers on Obamacare exchange participation in Louisiana point to problems in the law, even though they’re significantly lower than in previous years. In 2016, more than 216,000 Louisianans got their insurance off the exchanges, which offer subsidies to many customers. The figure has dropped every year since, and state officials say there are a couple of explanations: One is that some customers have migrated over to Medicaid, which Gov. John Bel Edwards expanded that year, largely on the federal dime, after his predecessor Bobby Jindal had refused to do so. Another is that more people are able to get insurance through their employers.

Officials say they don’t think Congress’s elimination of the individual mandate, which financially penalized people without insurance, made much of a dent, and that’s encouraging news. It means that people have gotten into the habit of protecting themselves, and see the value in doing so.

Yet this change, which was enacted as part of last year’s tax overhaul, is what put the whole ball of wax at risk once again, thanks for a sequence of events that started when Landry and fellow Republicans from 19 other states backed a Texas legal challenge claiming the change invalidated much of the law.

To widespread surprise, the federal judge overseeing the case went even beyond what the plaintiffs seemed to seek at the time, which was a ruling that Congress’s all-Republican vote to eliminate tax penalties on those who don’t carry insurance invalidates popular provisions such as protections for people with pre-existing conditions. Instead, U.S. District Judge Reed O’Connor declared that entire Obamacare law could not stand. And just this week, President Donald Trump’s Justice Department announced in a brief but momentous court filing that it agreed, and would not defend any part of the law in court.

Stephanie Grace: Ruling in Jeff Landry-backed health care lawsuit creates a mess

That’s not even close to the end of the story. The case is destined for the 5th Circuit Court of Appeals in New Orleans, and ultimately for the U.S. Supreme Court. And while it’s not clear how the administration’s new position affects the case’s prospects, it certainly revives the old national political fight.

Landry’s actions had already made the case a political issue here in Louisiana. When he put the state on record seeking to overturn the law, he did so without consulting the Democratic governor, who strongly objected. This week, in light of the Trump administration’s shift, he reiterated his position.

“We can all agree that the Affordable Care Act has flaws that we should be working to address, but completely eliminating the program — especially the provisions that protect people with pre-existing conditions, allow children to stay on their parents’ health plans, and the Medicaid expansion — is not the answer,” Edwards said. “We can fix what’s broken with the ACA without jeopardizing people’s health care.”

Remind me again what the argument against that is?


Follow Stephanie Grace on Twitter, @stephgracela.