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In the coming days, a federal court will decide whether the Affordable Care Act is unconstitutional, a ruling that could determine whether people with pre-existing medical conditions will continue to receive patient protections, or if insurance companies will once again be able to deny them life-saving coverage.

The lawsuit, filed by Arizona and 19 other Republican-led states in 2018, seeks to strike down the entire ACA, which would cause 297,000 Arizonans to lose their health insurance, leading to a 38% increase in the state’s uninsured rate, according to Protect Our Care, a group focused on protecting healthcare.

But perhaps alarmingly, repeal of the ACA could also leave the nearly 2.8 million Arizonans who live with pre-existing conditions — including more than 386,000 children — without critical patient protections. 

In effect, removal of these protections would once again allow insurance companies to deny coverage or charge higher premiums to those with pre-existing conditions. 

The most common types of pre-existing conditions include high blood pressure, behavioral health disorders, high cholesterol, and chronic lung disease, but the full list is far more expansive.

Here’s just a sampling of conditions that insurers declined or limited coverage for before the Affordable Care Act went into effect in 2014.

For those with one of these conditions, the U.S. Court of Appeals for the 5th Circuit’s upcoming ruling could directly impact the ability to receive health coverage. If the court sides with Republicans and rules the ACA is unconstitutional, the healthcare law would likely wind up before the Supreme Court for a third time.

Should the Supreme Court then ultimately strike down the ACA, millions of Arizonans could once again be denied life-saving coverage in the future.