The death of Supreme Court Justice Ruth Bader Ginsburg has left the Affordable Care Act (ACA) vulnerable to a being overturned by the highest court in the land. At this moment President Trump and Senator Majority Leader Mitch McConnell are moving quickly to fill Justice Ginsburg’s seat which could decidedly tip the balance of the Supreme Court for a generation.

And so the health care of millions of older adults once again hangs in the balance. As a reminder, in December 2019 a federal appeals court agreed with a lower court’s decision that the ACA’s requirement for most people to have health insurance is unconstitutional. The case was sent back to a Texas federal judge (who previously struck down the entire law) to determine how much of the health care law can survive.

A group of attorneys general led by California intervened to defend the health care law and appealed to the Supreme Court, which agreed to hear the case, now called California v. Texas, one week after the election in November.

If the district court’s ruling stands, it could throw the ACA into chaos — and affect millions of Americans whose health care and coverage were improved by the law. Here’s what that means for Medicare beneficiaries and those relying on Medicaid:

Prescription drug costs for older Americans will skyrocket.

Medicare recipients will be forced to pay increased costs for preventive services like wellness visits, diabetes screenings, mammograms, flu shots and even cancer screenings.

The Medicare Part A Hospital Insurance Trust Fund’s shortfall will be accelerated thanks to the loss of provider payment reforms in the ACA.

Americans who gained access to Medicaid, because the ACA expanded this program’s eligibility, would lose coverage.

On top of all that, millions of older Americans could see their health care premiums and deductibles spiral upwards, reversing a positive trend under the ACA of containing Medicare costs. And millions of Americans with pre-existing conditions could lose their health care coverage altogether!

The Trump Administration has repeatedly tried to overturn the ACA and sabotage this popular law — and now the future of this law even more uncertain. And so, our fight to protect this historic law just got a lot more difficult. Ultimately, this case is expected to be decided by the U.S. Supreme Court, which has upheld the health care law twice in the past.

The National Committee to Preserve Social Security and Medicare had decided to break with our 38-year tradition of steering clear of presidential campaigns by endorsing Joe Biden for President of the United States.

During the past four years, we’ve seen President Trump pay lip service to seniors’ needs while actively undermining their best interests. The latest example being his reckless pledge to terminate the payroll taxes that fund Social Security and Medicare which would result in benefits being unfunded.

Joe Biden and Kamala Harris will fight for older Americans and their earned benefits. The Biden plan for Social Security would expand benefits, lifting an additional half a million seniors out of poverty by 2030. He wants to add dental, vision and hearing coverage to traditional Medicare — and reduce what seniors pay for prescription drugs by allowing the government to negotiate prices with Big Pharma. He has proposed a groundbreaking, $775 billion plan to assist caregivers for the elderly and children. Finally, the former Vice President would strengthen — not decimate — the Affordable Care Act.

There is no doubt that the most effective way to protect and strengthen the federal government’s commitment to older Americans is to elect Joe Biden as president.