The Justice Department announced that it would support an appeals court decision that the entire Obamacare law should be thrown out. The decision reverses previous policy that supported keeping some protections for people with pre-existing conditions.

The federal judge's sweeping ruling last December was a blow to a group of Democratic-led states who had sued to stop several changes to the law from going into effect. That ruling is now being appealed and is likely to end up at the Supreme Court.

Politico:

"The Department of Justice has determined that the district court's judgment should be affirmed," three Justice Department lawyers wrote to the 5th Circuit Court of Appeals, which is now considering the case. "[T]he United States is not urging that any portion of the district court's judgment be reversed."

Regardless of the outcome, legal experts anticipate that the 5th Circuit's ruling will be appealed to the Supreme Court. If the courts ultimately strike down Obamacare — over the objections of a group of Democrat-led states, which have spent more than a year defending the health law in court — the consequences could be substantial for patients, health care organizations and other groups that have adapted to the nine-year-old law.

More than 20 million Americans are covered through the ACA's Medicaid expansion and its insurance exchanges. The sweeping law — the object of repeated legal challenges since its 2010 passage — has transformed the nation's health system, creating new patient protections and reshaping payments for doctors and hospitals.

Some of the Trump administration's proposed drug price reforms depend on provisions contained in the ACA. Senior Trump health officials haven't detailed how they would respond if all of Obamacare is struck down.

If this decision is upheld and Obamacare is finally killed, it would be the largest rollback of the welfare state in history. It would also result in millions of people being thrown off their insurance plans or unable to afford the premiums without the federal subsidy.

What of the 8 million people who took advantage of the expansion of Medicaid? States will probably pick up the slack for some of them. It's likely that Congress will try to address the problem of covering people with pre-existing conditions - if the two parties can agree on a plan. 

But no one who supports the repeal of Obamacare should have any illusions; it will throw the private insurance industry into chaos.

But insurance companies will eventually adapt. The mandated coverages that everyone had to pay for even if they didn't want them will be gone, which will give the industry the freedom to offer many more plans in various price ranges.  

But some people are going to fall through the cracks. Ending a major federal program like Obamacare will not be without pain, especially since the ACA has spread its tentacles throughout the healthcare industry. Ripping out those tentacles is not going to be easy.

A law that never should have been passed, sold to the American people with blatant lies, enacted along entirely partisan lines, and proved itself to be mostly unworkable could be eliminated entirely.

But its legacy will be felt for many years.