On February 26, 2018, Ken Paxton, the Texas attorney general, filed a 20-state lawsuit asking a federal court to strike down the entire Affordable Care Act so that Americans would be "free from the stranglehold of Obamacare." In December 2018 a federal judge in Texas declared the entire ACA unlawful, but on June 17, 2021 the Supreme Court dismissed the case by a 7-2 vote because the states "lack Article III standing as a matter of law."
Had the suit succeeded, it would have ended the law's ban on turning away people with pre-existing conditions, which covers millions of Texans, and the marketplace where most Texans who buy their own insurance get financial help. In July 2025 Paxton praised the One Big Beautiful Bill Act, which makes that Texas marketplace coverage harder to keep.
What It Cost and What It Sought: Texans' Coverage Under Ken Paxton's Affordable Care Act Lawsuit and the Law He Praised
- Pre-existing conditions. KFF estimated in 2016 that 27% of Texas adults under 65, or 4,536,000 people, had pre-existing conditions that would likely have left them uninsurable in the individual market before the Affordable Care Act; Paxton's suit asked the courts to end the law that protects them.
- Uninsured Texans. The Urban Institute estimated in March 2019 that full repeal of the Affordable Care Act, the result Paxton's suit asked for, would have left 1,733,000 more nonelderly Texans uninsured in 2019, an increase of 37 percent, and would have raised demand for uncompensated care in Texas by $3.3 billion, or 49.9 percent.
- Marketplace coverage. In February 2026, 3,277,198 Texans had marketplace coverage through HealthCare.gov, the exchange the Affordable Care Act created and Paxton's suit sought to end.
- Children's coverage. Without the health law, the Urban Institute estimated, 15.4 million low-income families and children would lose Medicaid and Children's Health Insurance Program coverage, USA Today reported in 2019.
- Public opinion. In KFF's October 2020 poll, taken weeks before the Supreme Court heard the Texas-led case, eight in ten adults (79%) said they did not want the Court to overturn the law's pre-existing condition protections, including 66% of Republicans, and 58% said the same of the entire law.
Ken Paxton's Lawsuit to End the Affordable Care Act and His Later Endorsement of Marketplace Cuts
- Paxton Led a 20-State Lawsuit in 2018 Asking the Courts to Strike Down the Entire Affordable Care Act. On February 26, 2018, Ken Paxton and Wisconsin's attorney general filed a 20-state lawsuit arguing that the Affordable Care Act fell once Congress zeroed out the individual mandate penalty; Paxton said, "Through our multi-state lawsuit, we hope to effectively repeal Obamacare." The GOP-led states who brought the lawsuit asked O'Connor to toss out the entire law, and in December 2018 Judge Reed O'Connor of the Northern District of Texas declared the entire ACA unlawful. In 2019 the Fifth Circuit affirmed in part and vacated in part and sent the case back, and the Supreme Court dismissed it on June 17, 2021. When the Texas judge ruled, about 10 million people had subsidized private insurance through the health law's insurance markets and an estimated 12 million low-income people were covered through its Medicaid expansion, the Associated Press reported, coverage the states asked the courts to end. The Urban Institute estimated that as many as 19.9 million Americans would lose health insurance if the challenge succeeded.
- Paxton Praised the 2025 Law Whose Marketplace Changes Will Leave 480,000 More Texans Uninsured. Ken Paxton posted on July 1, 2025 that the Senate-passed bill was "One step closer to massive tax cuts," and on July 3, 2025 that "President Trump's Big Beautiful Bill is HISTORIC legislation." The law he praised removes the caps on repaying excess advance premium tax credits starting with tax year 2026, and it ends premium tax credits for many lawfully present immigrants, including refugees, asylees, and people with Temporary Protected Status, from 2027. Under the first change, all premium tax credit recipients repay the full amount of any excess, no matter their income, KFF explains. KFF projects that the law alone will leave 480,000 more Texans uninsured in 2034.
- Paxton Promised Texans Relief From Worrying About Premiums After Suing to End the Law That Helps Pay Them. In his runoff victory speech on May 26, 2026, Ken Paxton said Texans deserve to "have a high quality of healthcare without being forced to stay up at night, worrying about how you're going to pay your monthly premium." The lawsuit he filed in 2018 asked the courts to end the whole Affordable Care Act, including the subsidies for private insurance through its markets, and the law he praised in 2025 makes Texans who receive too much of that help repay the full amount of any excess.
Frequently Asked Questions About Ken Paxton on Affordable Care Act lawsuit
Did Ken Paxton sue to overturn Obamacare?
Yes. Ken Paxton led the 20-state suit filed in February 2018 that asked the courts to strike down the entire Affordable Care Act. The Trump administration's Justice Department later sided with the states, telling the Fifth Circuit in March 2019 that the United States "is not urging that any portion of the district court's judgment to be reversed," USA Today reported.
What happened to Ken Paxton's lawsuit against the Affordable Care Act?
The Supreme Court dismissed Ken Paxton's Affordable Care Act lawsuit on June 17, 2021, ruling that Texas and the other states had not shown an injury that gave them standing to sue. Justice Stephen Breyer wrote for seven justices, and Justices Samuel Alito and Neil Gorsuch dissented; the Court did not rule on whether the law itself was valid.
Would Ken Paxton's lawsuit have ended protections for pre-existing conditions?
Ken Paxton's lawsuit would have ended them if it had succeeded. His suit asked the courts to strike down the whole Affordable Care Act, and in 2018 the Trump administration told the court that the parts of the law that should go included "the requirement that insurers must take all applicants for comprehensive coverage regardless of prior health history, including pre-existing conditions," the Associated Press reported.
Last updated: 2026-10-25