A decision in the case challenging the federal law is expected any day now.

Erin Tracy-Blackwood was 22 years old when she applied for health insurance for the first time as an adult. Working as a server in North Carolina, she had recently discovered she was pregnant.

“The Blue Cross guy laughed at me and told me no one would insure me because pregnancy was a pre-existing condition,” Tracy-Blackwood, now 40, recalled in an interview with COURIER. “I cried, felt defeated. I was young and unmarried, and just felt like my baby was going to die.”

Because she couldn’t afford to see an obstetrician for regular checkups, Tracy-Blackwood became hyper-aware about what she would put in her body. She researched various vitamins and made sure she ate well—she didn’t know what else to do. As for the delivery, she knew the hospital would have to admit her by law if she was in labor; she didn’t know, however, how she’d ever afford the bill.

“I can’t even tell you how many nights I spent crying because I thought something would be wrong,” Tracy-Blackwood said. Eventually, she learned about Medicaid from another young mother and signed up. By that point, she was seven months pregnant. 

“I can’t even tell you how many nights I spent crying because I thought something would be wrong.”

Tracy-Blackwood’s experience of being denied coverage happened in 2001—nine years before the Affordable Care Act (ACA) was signed into law. Thanks to this landmark healthcare reform law, insurance companies can no longer refuse to cover a person because they have a pre-existing condition.

Any day now, however, a ruling is set to be handed down in a legal challenge threatening the ACA’s future. If the law is ultimately repealed, millions of people with pre-existing conditions, and others, will be impacted. 

The case is Texas v. United States. Last year, a group of 20 states (two have since dropped out) led by Texas filed a lawsuit arguing that the healthcare law is now unconstitutional after Congress removed the tax penalty for not having health insurance, which was a key part of the Supreme Court’s decision to uphold the law in 2012. If the individual mandate is upheld as unconstitutional by the U.S. Court of Appeals for the 5th Circuit, the entire ACA could be invalidated. 

If that happens, the consequences could be devastating for everyone. As Slate points out, a repeal of the ACA “could be the single most consequential event of Trump’s presidency, and can sit right up there with the rescission of the Deferred Action for Childhood Arrivals program, the travel ban, and the family separation policy as humanitarian catastrophes.”

But women, especially women of color and low-wage workers, would likely be impacted the most. A recently updated Kaiser Family Foundation report found that a larger share of women under the age of 65 have declinable pre-existing conditions in 2018 compared to men in the same age group. 

“We estimate that 23.7 million men have a pre-existing condition that would have left them uninsurable in the individual market pre-ACA, compared to 30.1 million women,” the authors write. 

Another data set from the Center for American Progress and the National Partnership for Women & Families estimates that more than half of nonelderly women and girls in the United States—that is, nearly 68 million—have pre-existing conditions. The report also states that there are approximately 6 million pregnancies each year, which, as Tracy-Blackwood’s story shows, has historically been a commonly cited reason for denying coverage prior to the ACA. 

“A large share of women have insurance through an employer or Medicaid, and therefore, their coverage would protect them from discriminatory practices such as medical underwriting or denials based on health conditions,” the report’s authors write. “But the data make clear that allowing insurers to return to pre-ACA practices could lead to millions of women and girls being denied coverage or charged more based on their health status if they sought coverage in the individual market.”