Today, the Trump administration and 18 Republican governors and attorneys general will file their opening briefs with the Supreme Court in California v. Texas—the health care repeal lawsuit. Texas, and several other states, initially filed this lawsuit after the Affordable Care Act (ACA) became law, claiming the law unconstitutional. The Trump administration, siding with this stance, has taken several measures to dismantle the ACA, the largest of which was zeroing out the individual mandate penalty, after failing to repeal it altogether.

If the Supreme Court deems the ACA unconstitutional and strikes it down, 23.3 million Americans are at risk of losing health insurance coverage according to new CAP analysis—about 3 million (15 percent) more than was forecast before the coronavirus pandemic. But coverage loss isn’t the only concern when it comes to a repeal.

The Affordable Care Act provided certain consumer protections. Prior to the ACA, you could be denied coverage if you had a pre-existing condition; insurers weren’t required to spend premium dollars on patient care; and insurers weren’t required to cover certain prescription drugs, mental health care, and other currently essential health benefits. Not to mention, the affordability that came along with cost-sharing reductions and tax credits.

This means that millions will not be able to secure coverage due to preexisting conditions, and millions more will not be able to afford coverage, leaving them with viable options to secure health insurance and care.