As recently as last fall, President Trump assured Americans with existing medical conditions that he would “always protect” their access to health care.

But in a sharp reversal, the Trump administration has abandoned that promise.

The Justice Department now says that the entire Affordable Care Act — commonly known as Obamacare — should be struck down.

The surprise change came in a one-page filing with a federal appeals court that is considering the ruling of a federal judge in Texas nullifying the ACA.

“Because the case is before one of the most conservative appellate courts in the country,” reports CNN, “it almost guarantees that the issue will return to the newly solidified conservative Supreme Court at some point.”

“If the appeals court accepts the Trump administration’s new arguments,” writes the New York Times, “millions of people could lose health insurance, including those who gained coverage through the expansion of Medicaid and those who have private coverage subsidized by the federal government,” as well as those with pre-existing conditions.

Speaker Nancy Pelosi said Monday night the administration was declaring “all-out war on the health care of the American people.”

From Bloomberg:

“The health care filing could prove to be a gift for Democrats as they seek to refocus their messaging on issues important to voters. The debate over so-called Obamacare — which Republicans tried unsuccessfully to repeal in 2017 — caused heartburn for the party in the 2018 midterm elections and was a focal point for Democrats on the campaign trail.

The Times quotes Yale law professor Abbe R. Gluck, as saying the administration’s new filing amounts to “a total bombshell, which could have dire consequences for millions of people.”

“The administration’s move didn’t only startle supporters of the law. One former official who worked under [then-Attorney General Jeff] Sessions told CNN Monday night that he, too, was surprised by the new position.”

In a campaign speech last September in West Virginia, the president said this:

“I will always fight for, and always protect, patients with preexisting conditions,” he said. “You have to do it. You have to do it. Some people think that’s not a Republican thing to do.”

“I don’t care, and I’ll tell you what. All of the Republicans are coming in to that position now. All of them. And we’ll do it the right way too. Preexisting conditions are safe. OK? Just remember that. Preexisting — tell that to the fake news media when they write. Fakers.”

More recently, the Trump administration itself has used the ACA to push for lower prescription drug prices.

“In the nine years since it was signed by President Barack Obama, the Affordable Care Act has become embedded in the nation’s health care system,” the Times says. “It changed the way Medicare pays doctors, hospitals and other health care providers. It has unleashed a tidal wave of innovation in the delivery of health care. The health insurance industry has invented a new business model selling coverage to anyone who applies, regardless of any pre-existing conditions.”

The lawsuit at the heart of the current dispute — Texas v. United States — has divided the states on ideological lines. Filed last year by Texas and other Republican-led states, it is fiercely opposed by a group of Democratic states led by California.

“The Texas lawsuit ‘is as dangerous as it is reckless,’” the Times quotes California’s attorney general as saying.