On Tuesday, the Supreme Court declined to fast-track the latest challenge to the Affordable Care Act (ACA). This decision not to expedite review comes after a federal appeals court last month agreed with a federal judge in Texas that the ACA’s individual mandate is unconstitutional, but declined to say how much of the law should fall as a result. Instead, the appeals court sent the case back to the Texas court to reconsider that question—a process that could take months if not years.

In response, the coalition of Democratic-led states defending the health law asked the Supreme Court to hear the case this term, noting that prolonged uncertainty over the ACA’s fate could damage the nation’s health care system and put patients at risk. The U.S. House of Representatives, which is also defending the ACA in court, filed a similar petition asking for immediate Supreme Court review.

The Supreme Court typically prefers to let the lower court process play out before getting involved. However, some thought this case’s high stakes could prompt the Court to intervene. It takes five justices to agree to hear a case on an expedited basis. Having not met that threshold, the case will now continue to work its way through the lower courts.

Initially brought several years ago by a group of Republican state attorneys general and governors, and currently supported by the Trump administration, the plaintiffs argue the ACA is unconstitutional because Congress reduced the individual mandate penalty to zero in the 2017 tax bill. Though this argument was dismissed by many legal scholars, the district court found in favor of the plaintiffs, and the Trump Administration endorsed this ruling.

Importantly, the ACA remains in place as the case proceeds and, without immediate Supreme Court review, a resolution is unlikely in advance of the 2020 elections. Both parties sought to make health care a campaign cornerstone in recent years, and this ongoing lawsuit means the ACA is likely to be in the public eye again this cycle.

Medicare Rights continues to be troubled by this effort to invalidate the ACA, and by the Trump administration’s failure to defend the law in court. If the ACA were to fall, the impacts on older adults and people with disabilities would be devastating.

In particular, the health law’s improvements to the Medicare program—including limiting costs, expanding coverage for preventative care, and closing the Part D donut hole—continue to be critical for beneficiary access and affordability, as well as the program’s sustainability.

The loss of the ACA would also end the Medicaid expansion that has improved coverage, access to care, and economic outcomes for low-income adults, and would eliminate consumer protections in private insurance that prevent denial of coverage for pre-existing conditions. This could leave some or all of the estimated 133 million Americans under 65 with pre-existing conditions without affordable coverage. It would also mean the return of lifetime caps on coverage and of the overly punitive “age tax” for older people seeking to purchase insurance.

We strongly urge states and the Trump administration to abandon efforts to undermine the ACA, and to instead work together to improve health care and coverage for all Americans.

Read more from Medicare Rights about the ACA’s coverage expansions and consumer protections.