Nearly every U.S. resident would be impacted in some way if the Trump administration gets its way and the entire Affordable Care Act (ACA) is invalidated in court.

Susan Lyon of California, for example, is deeply concerned for her husband and business partner who has Parkinson’s disease. Without the ACA, she suspects her insurance would charge a lot more because of her husband’s pre-existing condition. She purchases health insurance through the ACA’s Small Business Health Options Program, meaning premium spikes would affect all nine of her full-time employees.

“It’s just terrifying” Lyon told ThinkProgress. “I have to put a lot of time and energy into this and this is energy I’m not putting into the business.”

She’s even planned for a scenario where her husband loses insurance because of his medical condition: He’d leave the family business to try to get on disability until he is eligible for Medicare in a decade.


“Somebody with lifetime employment — they just really don’t understand what it’s like,” said Lyon, referring to Supreme Court justices.

It terrifies Elena Hung of Maryland that there’s even the slightest possibility that insurers can reinstate lifetime dollar limits on benefits and discriminate against people with pre-existing conditions. While her daughter Xiomara has multiple, serious health issues, she’s always been able to get the care she needs because she was born after ACA.

“I wasn’t worried about our medical bills. I wasn’t sitting here trying to sell things so I can pay for her bills or worry about unpaid bills — that’s what the ACA has meant for so many families and to have that under threat is just absolutely devastating,” said Hung, co-founder of the advocacy organization Little Lobbyists.

Hung became an activist the last time the ACA was in peril — when Republicans tried to repeal the ACA and replace it with something far less comparable. Now, the health insurance of millions is at risk thanks to a federal judge in Texas who ruled last year that no part of the ACA could stand without the individual mandate, a tax penalty imposed on those who opt not to have insurance.

Republicans eliminated the mandate in their 2017 tax bill. While the Texas judge’s decision won’t actually take effect until it goes through the appeals process, the Trump administration sided with the judge; the administration said as much in a letter deeming the entire 2010 health law unconstitutional.


President Donald Trump told reporters on Wednesday the lawsuit gives the GOP another chance at health care, saying “if the Supreme Court rules that Obamacare is out, we will have a plan that is far better than Obamacare.”

Unlike the GOP health bill, activists likely won’t be able to influence the decision in a lawsuit.

“The attacks are coming from all different areas and so it’s hard to say when that peace of mind is — when we can all collectively breath again,” Hung told ThinkProgress.

Meanwhile, people are frightened. A recent Kaiser Family Foundation poll found that over half of the public are very concerned that they or someone in their family will pay more for health care if the courts side with the Trump administration. Nearly half are worried that they or a family member will lose coverage altogether. So, while it’s tempting to focus on the politics of it all — with some framing the issue as a win for Democrats eager to best Trump on health care — it’s important to remember real people stand to lose.

The number of uninsured people would increase by 21 million people, or 70 percent

Roughly 21.2 million more people will lose health insurance should the ACA be struck down — that’s an increase of about 70 percent, according to an Urban Institute analysis. People who purchased health care on the exchanges with federal subsidies or gained coverage through Medicaid expansion are most at risk.


The effects vary considerably by state. People living in states where officials embraced the ACA and thus reduced their uninsured populations would experience the greatest relative loss. For example, the number of uninsured in Kentucky would increase by nearly 151 percent, or to 379,000 people, compared with only a 12 percent increase in South Dakota which, as the researchers note, has not expanded Medicaid eligibility and has had low HealthCare.gov enrollment.

Black and Latinx people made major gains under the ACA and would be among the hardest hit. While there’s definitely room for improvement, the ACA helped lower the uninsured rate for black residents by more than one-third between 2013 to 2016, or from 18.9 to 11.7 percent, according the Center for Budget and Policy Priorities.

Uncompensated care would increase by $53.3 billion

Substantial increases in the number of uninsured means increases in the demand of uncompensated care. Care provided to people who can’t pay for it is financed by the federal, state, and local governments, as well as by health providers.

“Funding for uncompensated care is not guaranteed to increase to meet this additional demand; consequently, a significant share of this increased demand could translate into further unmet medical need,” according to the Urban Institute.

Millions have pre-existing conditions that insurance companies can use as basis to deny coverage

As many as 133 million U.S. residents may have a pre-existing condition. Without the protections granted by the ACA, these individuals are at risk of losing coverage, as insurance companies may choose to deny health coverage or charge higher premiums, according to a government study. Pre-existing conditions includes common medical ailments, like high blood pressure, high cholesterol, asthma, or chronic lung disease.

Before the ACA, even being a woman was a pre-existing condition. Indeed, insurers would routinely deny women health coverage because of their gender or charge them higher premiums. Prior to 2014, most individual plans wouldn’t even provide maternity coverage and yet these plans charged women at least 30 percent more than men.

While far from perfect, the ACA — all 900-plus pages — is intertwined with the health care system. The health law is also critical to solving the opioid crisis and even the president’s own plan to reduce prescription drug costs. As the president roots for the Supreme Court to strike down the ACA, it’s critical to take note of the human consequences.