If the Affordable Care Act (ACA) is overturned, almost every American will feel the effect in some way, according to an analysis by the Kaiser Family Foundation. The U.S. Supreme Court is scheduled to rule on a case challenging the ACA, just a week after the 2020 Presidential election on Nov. 3.

The Trump administration supports the lawsuit, which was brought by several Republican state officials in 2017, and wants the court to completely invalidate former President Barack Obama’s signature domestic policy.

The success of the lawsuit was considered a long shot, according to the news website Axios. But that was before the Sept. 18 death of Associate Justice Ruth Bader Ginsburg. It is possible that the case will be heard with a new associate justice appointed by President Donald Trump to fill her seat on the court.

Signed into law in 2010

The ACA, also known as Obamacare, was signed into law in 2010. It created a private health insurance marketplace, with sliding-scale subsidies and expanded Medicaid eligibility.

As of February 2020, 10.7 million people received healthcare coverage through insurance marketplaces set up under the ACA, according to the Kaiser foundation. Of those people, 9.2 million receive premium tax credits, while 5.3 million have cost-sharing reductions.

However, the ACA was challenged in court almost as soon as it took effect.

Court challenges

In 2012, the Supreme Court struck down the mandate that required most citizens and legal residents to have health insurance. Chief Justice John Roberts sided with the court’s four liberal justices to save the rest of the ACA.

In 2017, several state attorneys general filed the current case, saying that without the insurance mandate, the rest of the law should fall. A federal appeals court upheld the suit in late 2019, setting the stage for the November showdown at the Supreme Court.

Meanwhile, from 2010 to 2016, the number of uninsured Americans fell by 20 million, according to Kaiser. Since then, the number of uninsured has increased by 2.3 million.

Approximately 12 million Medicaid recipients in 33 states and the District of Columbia were eligible through expanded Medicaid eligibility as of June 2019, Kaiser reported. That includes 3.7 million in California and at least half a million each in Pennsylvania, Michigan, Illinois, Washington, Ohio and New Jersey.

Pre-existing conditions covered

Insurers are not allowed to deny coverage to an estimated 54 million Americans who have pre-existing conditions, or to charge higher premiums based on health status or gender. Kaiser noted that many of these people might have been unable to find insurance before ACA, because of their pre-existing conditions. That would affect one-third of the residents in states like Alabama, Arkansas, Kentucky, Louisiana, Mississippi and West Virginia.

The law also does not allow insurers to withdraw coverage when someone falls ill, nor can they impose yearly or lifetime coverage limits. In addition, private insurers must also cover, free of charge, a wide array of preventive services, including recommended cancer and chronic condition screenings and immunizations. Those same services are generally covered for the 150 million Americans enrolled in employer plans or through individual market insurance, according to Kaiser.

The ACA has allowed 2.3 million young adults to have insurance through their parents’ plans, up to the age of 26.

The law also phased out the Medicare coverage gap, the so-called “doughnut-hole,” for 46 million beneficiaries by slowly reducing the drug costs paid by enrollees in the Part D prescription plan.

Robert Calandra is an award-winning journalist and book author who has written extensively about health and medicine. His work has appeared in national and regional magazines and newspapers.