Today, the Supreme Court of the United States will take up a case that could upend our health care system. California v. Texas, a lawsuit brought by 18 state Attorneys General including West Virginia’s Patrick Morrisey, seeks to overturn the entire Affordable Care Act (ACA).

If all or most of the law is struck down by the Supreme Court, nearly every family in the United States will be impacted. Twenty-one million Americans could lose their health care coverage, including 198,000 West Virginians, nearly tripling our state’s uninsured rate.

Pre-existing condition protections for non-elderly adults, including 382,000 West Virginians, could be stripped away. Advances in improving longstanding racial disparities in health coverage and health outcomes would very likely be lost. Additional protections at risk include coverage for young people under their parents’ insurance up to the age of 26, preventive care and birth control with no cost-sharing, subsidies to make health coverage more affordable for people who don’t get coverage through their jobs, and a requirement that insurers cover mental health and maternity care.

In West Virginia, there is perhaps even more at stake. Despite partisan divide over the ACA itself, West Virginia’s state lawmakers on both sides of the aisle have utilized provisions of the health care law to provide and expand health benefits that meet the specific needs of West Virginians.

For example, in 2018, West Virginia was approved to provide expanded benefits to Medicaid enrollees who have Substance Use Disorders (SUD). This allowed the state to pull down federal Medicaid dollars to cover the cost of medication assisted treatment (MAT) like methadone and to create a statewide initiative to make naloxone, the drug that reverses overdoses, widely available. If the ACA is overturned, tens of thousands of West Virginians who have SUD and rely on the Medicaid expansion would likely lose their health coverage and access to critical treatment and recovery services.

Earlier this year, the state legislature passed SB 648, which provides dental benefits to over 300,000 adults who rely on Medicaid, with overwhelming bipartisan support. This important benefit is expected to improve overall health and save the state money in the long run as oral health issues are linked to more complex health problems like heart disease, diabetes, and pregnancy complications. If the ACA is overturned and the Medicaid expansion is eliminated, over half of the adults who were expected to gain access to dental benefits under this law could not only lose their health coverage but also the new dental benefit. Additionally, West Virginia will lose the nine-to-one match that would have made the federal government responsible for covering 90 percent of the costs of dental benefits for this population.

California v. Texas also threatens West Virginia’s ability to build on these innovative policies by expanding health coverage even further. Our organizations are founding members of the Health Care for All West Virginia coalition. Last month we unveiled our 2021 state legislative agenda. Several of our health policy priorities, which have legislative champions from both parties, would either no longer be possible or no longer provide wide-ranging benefits if the ACA is overturned. This includes a Medicaid buy-in, which would allow adults to purchase Medicaid-like coverage with federal or state dollars, vision benefits for adult Medicaid enrollees, permanent telehealth benefits, and expansion of Medicaid to cover non-medical factors that impact the social determinants of health.

While the ACA is not perfect and our ultimate goal is to achieve universal coverage, it represents a major positive advancement for health care and our residents. Moreover we’ve been able to utilize the flexibilities in the law to improve the ability of our state’s health care system to address the specific needs of our people. Overturning the health care law would be devasting for West Virginia families and our future.

— This guest column was authored by founding members of the Health Care for All WV coalition: Kelly Allen, executive director of the WV Center on Budget and Policy, Jessica Ice, executive director of West Virginians for Affordable Health Care and Gary Zuckett, executive director of West Virginia Citizen Action Education Fund.