Today, opponents of the Affordable Care Act (ACA)—which include 18 states and the Trump administration—must file opening briefs with the U.S. Supreme Court in the next stage of their attempt to dismantle the health care law. If successful, this lawsuit would strip health care coverage from millions of Americans, including people approaching Medicare eligibility due to age or disability, reopen the Medicare Part D donut hole, end Medicaid expansion, and allow insurers to deny coverage and institute lifetime maximums on an estimated 133 million Americans with pre-existing conditions.

Two years ago, in a widely panned decision, a federal judge in Texas found that the entire ACA is unconstitutional because Congress reduced the individual mandate tax penalty to zero. The Trump administration applauded this decision and encouraged the courts to strike down the ACA, Late last year, an appeals court agreed that at least part of the ACA should fall but did not strike down the entire law. This decision was appealed, and so the ruling had no immediate impact—the ACA remains the law of the land. Now, the case has reached the Supreme Court. The justices plan to hear oral arguments this fall, and a ruling is likely in 2021. Given the COVID-19 public health emergency, the stakes have grown even higher.

The elimination of the ACA would have particularly dire effects on communities of color. Black and Hispanic/Latino populations would face huge increases in the number of uninsured. This would come on top of COVID-19’s disparate impacts, including greater rates of infection, serious illness, and death.

Tearing health coverage away from millions is unacceptable in the best of times. Doing so during a pandemic is wildly irresponsible and cruel. Importantly, a reinstituted ability for individual and employer-based plans to discriminate against people with pre-existing conditions would include those suffering the after-effects of COVID-19—which are still not fully known—and those who have been forced to go without care for their chronic or new conditions during the public health emergency.

The ACA also directly changed the Medicare program for the better, by extending coverage for preventive care services and eliminating the drug plan donut hole, saving people with Medicare millions of dollars . In addition, the ACA prohibits Medicare Advantage plans from imposing higher cost-sharing on chemotherapy, renal dialysis, skilled nursing care, as well as other services, to prevent them from discouraging higher cost patients from enrolling in their plans. Undoing these improvements would adversely affect the health and economic security of Medicare beneficiaries.

Perhaps the most damaging result would be the rollback of the ACA’s Medicaid expansion, which allows states to cover low-income adults ages 19 to 64. Prior to the ACA, these individuals were generally not eligible for Medicaid. State decisions not to expand coverage are estimated to have cost the lives of 15,000 people  between ages 55 and 64. Before the ACA, the Medicaid expansion population had similar mortality trends no matter where they lived. After the ACA, however, those in non-expansion states began dying at a higher rate.

The health, life, well-being, and economic toll of being uninsured is plain. At Medicare Rights, we urge states and the federal government to work to ensure high-quality health care and coverage for everyone. This lawsuit would have the opposite effect, with devastating consequences.