The ACA’s provision banning insurance companies from denying coverage to people with pre-existing conditions has been life-changing for Kellye Call, who has autoimmune disease.

The US Supreme Court signaled Tuesday that it is likely to uphold the Affordable Care Act (ACA), despite the efforts of 18 Republican-led states and the Trump administration to repeal the landmark healthcare law. More than 20 million Americans have health insurance because of the ACA, which also guarantees protections for millions more who live with pre-existing medical conditions.

Two of the Court’s conservative members—Chief Justice John Roberts and Justice Brett Kavanaugh—criticized the basis of the lawsuit, arguing that Congress’s 2017 decision to effectively eliminate the penalty for not buying health insurance did not serve as grounds to declare the entire law unconstitutional. Roberts also said that Congress’ decision did not serve as a clear desire to gut the entire law. 

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“I think it’s hard for you to argue that Congress intended the entire act to fall … when the same Congress that lowered the penalty to zero did not even try to repeal the rest of the act,” Roberts told Kyle D. Hawkins, the Texas solicitor general leading the lawsuit. “I think, frankly, that they wanted the court to do that. But that’s not our job.”

In staking out this ground, Roberts and Kavanaugh appear poised to side with the court’s three liberal justices and reject the Republican attempt to repeal the law, as the Court has done twice before. But a decision in the case is not expected for months, and millions of Americans who rely on the law for coverage or protection remain uneasy. 

She Takes 10 Medications a Day and Needs This Safety Net

Kellye Call is one of those Americans. The 30-year-old resident of Athens, Georgia, was diagnosed with her first autoimmune disease at the age of 15. Since then, she’s been diagnosed with several more. The ACA’s provision banning insurance companies from denying coverage to people with pre-existing conditions has been life-changing for Call. 

READ MORE: They Overhauled Health Care. It Saved My Life.

“Before the ACA I was frequently denied services like medications, specialist visits, and blood tests, simply because I had a pre-existing condition,” Call told COURIER. “I remember my mom sitting me down at the age of 15 and teaching me how to appeal a denial, because she told me I would be doing that for the rest of my life, and until 2010-2011, she was right. I was doing that quite frequently and it was perfectly legal for them to deny me whenever they felt they could.”

Since the ACA was passed in 2010, however, it has become easier for Call to get care. She’s never relied on the ACA marketplace for coverage, but the law has provided her with a “safety net” when she fights with her insurance companies over claims. 

She also benefited from the law’s other provisions, which allowed her to remain on her parents’ insurance plan until she was 26. The law also banned insurance companies from placing annual or lifetime dollar limits on the benefits she receives.

“Even though I don’t have anything totally serious or terminal, I was still at risk of hitting lifetime caps just because medications and specialist visits and lab tests are very expensive, and so that fear was taken away,” Call said. 

“I remember my mom sitting me down at the age of 15 and teaching me how to appeal a denial, because she told me I would be doing that for the rest of my life, and until 2010-2011, she was right.”

If she had hit those caps, Call would have had to either forgo medication or pay for it out of pocket. “I take 10 medications a day, which can be very expensive if not covered, and these medications are all things that I need to ensure that I have a good quality of life,” she said. “Because of the ACA … I am not in debt over my medical bills.”

While the law itself has provided Call with a crucial safety net, the Republican Party’s decade-long quest to repeal the ACA without providing a suitable alternative has been “emotionally damaging.”

“It’s a lot of emotional labor to feel like you don’t know if you’ll continue to have coverage. I fight enough with my insurance companies, which takes a lot out of me. I don’t need to fight with elected representatives over my right to have health insurance,” she said. “To have it attacked every year with no plan in place is scary—it has a very real impact for a lot of us.”

Call is nervous that the Supreme Court case could spell the end of the ACA, despite its broad popularity, and has no faith the GOP will live up to its promises to replace the law with something better.

“They have nothing,” she said bluntly. 

A Democrat-Controlled Senate Could Help Expand the ACA

Instead of repealing the ACA, Call wants lawmakers to improve upon it. President-elect Joe Biden has pledged to do just that by creating a public health insurance option and expanding the ACA’s subsidies to provide consumers with more financial assistance when they select their coverage.

That plan, however, depends on Democrats also controlling the US Senate, which ironically will be decided by Call’s state of Georgia. If Jon Ossoff and Raphael Warnock can defeat incumbent Republican Sens. David Perdue and Kelly Loeffler in January’s runoff elections, the Senate would be split 50-50, with Vice President-elect Kamala Harris serving as the tie-breaking vote. This could allow Biden to enact his healthcare agenda through the budget reconciliation process, which requires only a simple Senate majority rather than the traditional 60 votes needed to pass legislation.

Even if Democrats win those runoffs, however, the Supreme Court could still throw a wrench in any plan to expand the law. If Kavanaugh and Roberts for some reason pivot away from their stances on Tuesday, it could spell the end of the ACA. 

Such an outcome would be beyond devastating for Call. 

“If the ACA were struck down, I would, quite frankly, become disabled. Because I have my specialists covered, because I have my medications covered, because I have my blood tests covered, I’m in remission on all of my diseases. Because of this, I’m able to be in grad school right now and obtain two masters degrees, and I will be able to work after that and do the work that I like to do,” she said. “If I don’t have my doctor’s visits and my medications and I [can’t] manage my disease, I don’t have a quality of life. I won’t be able to get out of bed in the morning. I don’t want that to happen, and I especially don’t want that to happen at 30 years old.”

READ MORE: This Minneapolis Mother Depends on the ACA to Survive. The Supreme Court Could Upend Her Life.