If you’re over 50 and live in Arizona, an upcoming federal court ruling on the Affordable Care Act could impact how much you pay for healthcare in the future. 

The U.S. Court of Appeals for the 5th Circuit is expected to issue a ruling in the coming days regarding a 2018 lawsuit filed by Arizona and 19 other Republican-led states seeking to strike down the entire ACA.

Should the court rule the ACA is unconstitutional — and should the Supreme Court uphold that ruling — it could worsen the issue of already-rising healthcare costs. 

Fifty-one percent of Arizonans said their health-care costs have gone up in the past two years, and 65% found it “extremely” or “very” concerning that Republicans are pushing to repeal the ACA without a plan to replace it, according to an August 2019 poll from Public Policy Polling (PPP). 

The battle over the ACA has turned healthcare into a critical issue for Arizonans, with 84% saying it was a “top” or “important” priority, according to the same PPP poll. The poll is particularly representative of older Arizonans’ concerns, as 45% percent of the 680 respondents were between the ages of 46 and 65.

Healthcare has long been a significant expense for people over 50, particularly retirees, who see their yearly costs go from $4,000 when they’re working to roughly $6,500 when they retire, according to the US World & News Report

These costs have made it difficult for older Americans to afford their healthcare bills. A March 2019 report from West Health and Gallup found that seniors have withdrawn an estimated $22 billion from long-term savings to pay for healthcare, yet 7.5 million seniors still remain unable to pay for their prescription drugs. The poll of more than 3,500 Americans also found that 73% of seniors reported being concerned that healthcare costs would continue to rise. 

To make matters worse, Arizona’s healthcare system is already among the worst in the nation, ranking 41st in the country according to a survey from WalletHub.com. The state also ranks 31st in the nation in the United Health Foundation’s 2018 state rankings of healthcare for seniors, despite having one of the nation’s largest percentage of seniors. 

If the ACA is repealed, Arizona’s nearly two million residents 50 or older could see their healthcare costs surge even higher.  

Arizonans already faced this threat once, in 2017, when Republicans set out to repeal the ACA and replace it with a bill that would have allowed insurance companies charge people over 50 five times more than younger customers, according to the nonpartisan Congressional Budget Office. 

Despite saying she wanted to lower healthcare costs for seniors, Arizona’s own Sen. Martha McSally (R-Ariz), then a member of the House, was among those who voted to “repeal and replace” the ACA, infamously telling her colleagues they needed to get the “f-cking thing” done. 

Republicans claimed their replacement bill would lower costs, but it actually would have raised out-of-pocket healthcare costs for Arizonans over 50 by as much as $13,977 by 2020, and by nearly $20,000 by 2026, according to an estimate from the Center for American Progress, a left-leaning policy institute.

The AARP slammed the bill and said it would slap older Arizonans with an “age tax,” which would have taken Arizona’s already unaffordable healthcare costs to a whole new level. 

Though they failed in 2017, Republicans are trying to strike down the ACA again, this time using the courts. 

If the PPP poll is any indication, these attacks have Arizonans on edge and wary of McSally; a plurality of respondents to the PPP poll (45%) said they did not believe Sen. McSally could be trusted on the issue of health care. 

Should the courts strike down the ACA, older Arizonans could once again find themselves facing higher premiums and out-of-pocket costs. Overturning the law would be “very disruptive,” particularly for seniors who are covered under Medicare, Tricia Neuman, a senior vice president for the Kaiser Family Foundation, told the New York Times.

Such a disruption could send healthcare costs surging for the two million Arizonans over 50, a number that will only increase as Arizona continues to grow.