New Orleans was the site of a major federal court hearing as the Fifth Circuit Court of Appeals heard oral arguments in Texas v. United States. The lawsuit challenges the constitutionality of the Affordable Care Act (ACA), widely known as Obamacare.

The ACA was signed into law by President Barack Obama in March 2010. President Donald Trump and Republicans in Congress have vowed to end Obamacare, and the battle has moved to the courts. The latest lawsuit follows a December 2018 ruling by a U.S. District Court judge in Texas who declared the ACA unconstitutional. 

The suit to uphold that decision is currently led by Republican Attorney Generals from 18 states, many of them in so-called “Red” states, including Texas, Alabama, Florida and Georgia. However, California Attorney General Xavier Becerra is leading a legal coalition of 20 states and the District of Columbia who say there will be dire consequences if the ACA is dismantled.

While Trump signed an executive order in June 2019 which noted “my administration seeks to enhance the ability of patients to choose the healthcare that is best for them,” critics say he hasn’t offered a viable replacement.

Though the Trump Administration initially sought to have only the ACA’s pre-existing condition protections deemed unconstitutional, it now supports the lower court ruling that found the ACA unconstitutional. That said, the ACA will be enforced absent a final judicial decision to the contrary.

Meanwhile, a morass of legal issues remain. One major point of contention is whether a 2017 decision by Congress to do away with the individual mandate penalty in the ACA renders the law unconstitutional; a previous Supreme Court decision centered around tax rules and was deemed legally appropriate.

On Tuesday (July 9), three U.S. Court of Appeals judges (two of them appointed by Republican presidents, including Trump) heard oral arguments. Based on certain questions, some experts have predicted it doesn’t look good for the survival of Obamacare. There’s no word on when the judges’ ruling will come, but whatever decision they render is expected to set up a scenario leading to additional legal challenges, including further consideration by the highest court in the land.

Democrats in Congress, including House Speaker Nancy Pelosi (D-CA), Senate Minority Leader Chuck Schumer (D-NY) and several members of the Congressional Black Caucus (CBC), rallied on the steps of the U.S. Capitol in Washington, D.C., on Tuesday. Some lawmakers held posters and photos of constituents impacted by healthcare costs, and asserted that gutting the ACA could prove disastrous.

“Millions of people’s lives, nothing less, are on the line,” Schumer said in a statement to BET. “If the right-wing wins the lawsuit, families from one end of America to the other will lose; lose their healthcare, lose important pre-existing condition protections, and lose their peace of mind that there might be something there to make them well.”

Data shows the signature achievement of the Obama Administration has led to nearly 20 million Americans gaining health coverage, protections for some 133 million people with pre-existing conditions, and tax credits for consumers to afford insurance.

The Center on Budget and Policy Priorities noted the African-American uninsured rate dropped by more than a third because of the ACA; the same report noted pre-Obamacare, African-Americans had higher uninsured rates than whites and Asians. 

For Black women (who studies show have higher rates of diabetes and are more likely to die from cancer and pregnancy-related complications), the removal of ACA protections could increase barriers that prevent access to quality health care including birth control, cancer screenings and affordable prenatal and postpartum care.

Supporters of the ACA say dismantling it would cost the United States between $150 and $350 billion over the next decade. 

An audio recording of oral arguments in the case can be found here.