The U.S. Supreme Court agreed to hear oral arguments on two cases challenging the Affordable Care Act a week after Election Day in November. This is the seventh challenge to the landmark health care bill in eight years, and if it is successful, it could have far-reaching consequences for health care in the United States.

The cases, Texas v. California and California v. Texas, ask whether a repeal of the individual mandate in 2017 means the whole law must be repealed. The individual mandate, an original provision of the Affordable Care Act, would have penalized those who don’t have health insurance with a fee, but a tax bill passed in 2017 zeroed out the penalty, effectively nullifying it.

According to an analysis by the progressive think tank Center for American Progress, 2.5 million Coloradans could lose their health insurance if the law is repealed.

If the law is overturned, it would revert health care markets to what they were before 2010, when insurance companies could deny coverage to people with pre-existing conditions or illnesses.

Republicans have insisted that if the Affordable Care Act is repealed, Congress will come up with an alternative to protect those with pre-existing conditions, but so far, there has been no consensus on a replacement despite years of repeal attempts.

Sen. Cory Gardner, R-Colo., introduced the “Pre-Existing Conditions Protection Act of 2020” on Aug. 6. The law’s stated aim is to prohibit insurance providers from excluding those with pre-existing conditions from coverage or basing premiums on that condition.

“My bill is simple – it guarantees coverage for people who have pre-existing medical conditions and ensures that people cannot be charged more because of a pre-existing condition,” Gardner said in an Aug. 7 news release. “I will continue to fight for pre-existing condition protections as well as measures to lower health care costs, strengthen innovation and expand access for all Coloradans, including those with pre-existing medical conditions.”

But advocates say the law is more of a stunt than a genuine protection, pointing out Colorado law and the Affordable Care Act require people with pre-existing conditions to be covered.

Gardner has voted several times to repeal the Affordable Care Act, including three instances in 2017. His Senate website includes a sentence saying “fixing our health care system will require repealing the Affordable Care Act and replacing it with patient-centered solutions, which empower Americans and their doctors.”

Larry Levitt, executive vice president of the Kaiser Family Foundation, wrote on Twitter Thursday that any attempt to shore up protections for people with pre-existing conditions if the Affordable Care Act is repealed would need to include several elements, including a community rating to determine prices and a ban on annual or lifetime limits for care.

“The ACA includes income-based subsidies to make health insurance more affordable and encourage people to sign up before they get sick,” Levitt said. “Without some mechanism like that, protections for people with pre-existing conditions would cause a premium ‘death spiral.’”

Jacob Wallace is an intern for The Durango Herald and The Journal in Cortez and a student at American University in Washington, D.C.