The intent of the Affordable Care Act was to help as many Americans as possible to get, and keep, health coverage. And it's done its job so well in that respect that if the recent decision by a Texas judge to declare it unconstitutional is upheld, nearly every American will be affected.

According to a new analysis from the Kaiser Family Foundation, it's not just those with pre-existing conditions or those who need the ACA's subsidies to help them afford coverage who will be affected.

KFF points out that the law went way beyond just those needs, and did a lot more than create health insurance exchanges; it also expanded Medicaid eligibility, imposed new requirements for employer-provided benefits, expanded preventive services, gradually closes the “donut hole” gap in Medicare drug coverage, cut Medicare payments to health providers and insurers, added new national initiatives to promote public health and raise quality of care, and created a range of tax increases to fund expanded health coverage.

And all that cut the number of uninsured nonelderly Americans by 19.1 million people from 2010 to 2017 as its various provisions took effect. But it all could go up in smoke if U.S. District Judge Reed O'Connor's ruling is upheld.

Medicaid expansion alone accounted for the addition of nearly 13 million new enrollees in 32 states and Washington, D.C. Adult children would no longer be able to remain on their parents' plan till they turn 26. Federal subsidies and cost-sharing reductions would go away, leaving lower-income families—8.9 million individuals who got premium tax credits and 5.4 million who got cost-sharing reductions (as of June 2018)—adrift, without the financial help to pay for coverage.

Defined minimum benefits such as hospitalization, maternity care, mental health and prescription drug coverage would no longer be required, while insurers could turn away potential customers or charge them more for having preexisting conditions or for gender or health status, revoke coverage if they get sick or limit their coverage annually or for their lifetime. Since more than 52 million people have preexisting conditions, that covers a lot of ground.

And forget about caps to out-of-pocket spending (the ACA caps it at $7,900 for an individual and $15,800 for family coverage in 2019) or coverage of preventive services at no out-of-pocket costs. Then there's the “donut hole” in Medicare Part D coverage, which is being phased out by the ACA—but that too will stop, leaving seniors on the hook for higher drug costs.

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ACA strikedown would affect nearly all Americans

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