Advocates say that people with disabilities have a lot to lose as the U.S. Supreme Court considers whether or not to strike down the Affordable Care Act.

The high court heard arguments Tuesday in a case brought by Texas and backed by the Trump administration and several other Republican-led states challenging the federal health care law.

The suit, California v. Texas, alleges that the law’s “individual mandate,” requiring that most Americans buy health insurance or pay a penalty, is unconstitutional because Congress eliminated the penalty in 2017. Accordingly, those who brought the claim say that given how central the mandate is to the law, the Affordable Care Act should be thrown out in its entirety.

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With the Trump administration supporting the Texas position, California and a group of Democratic-leaning states as well as the House of Representatives are defending the law.

Nineteen national disability advocacy groups filed an amicus brief with the Supreme Court urging that the law be upheld, arguing that it “uniquely and extensively benefits people with disabilities.”

Not only does the Affordable Care Act greatly increase opportunities for people to gain health insurance, but the law protects people from being denied coverage due to pre-existing conditions or lifetime limits. It also guarantees coverage of services for mental illness and developmental disabilities, provides access to home health care and bars discrimination in access to health care, the advocates said.

“By including these provisions, Congress intentionally sought to benefit people with disabilities,” reads the amicus brief. “It would not have wanted to sacrifice all of these protections merely because the minimum-coverage provision were declared invalid.”

Groups involved in filing the brief include the American Association of People with Disabilities, The Arc, the Association of University Centers on Disabilities, the Autistic Self Advocacy Network, the Autism Society, the Judge David L. Bazelon Center for Mental Health Law, the National Association of Councils on Developmental Disabilities, the National Council on Independent Living, the National Disability Rights Network and the National Down Syndrome Congress, among others.

In oral arguments conducted by telephone this week, multiple justices seemed hesitant to do away with the entire law.

“I think it’s hard for you to argue that Congress intended the entire act to fall if the mandate were struck down when the same Congress that lowered the penalty to zero did not even try to repeal the rest of the act,” said Chief Justice John Roberts. “I think, frankly, that they wanted the court to do that. But that’s not our job.”

Similarly, Justice Brett Kavanaugh did not seem inclined to strike the whole Affordable Care Act even if the individual mandate is found unconstitutional.

“I tend to agree with you that it’s a very straightforward case for severability under our precedents, meaning that we would excise the mandate and leave the rest of the act in place,” Kavanaugh said.

Disability advocates said the importance of the Affordable Care Act and the court’s determination in this case could not be more significant.

“People with disabilities have long struggled to access health care that actually meets their needs,” said Alison Barkoff, director of advocacy at the Center for Public Representation, which was part of the amicus brief. “The ACA’s protections for people with pre-existing conditions, essential health benefits and Medicaid expansion are tremendous advancements in that fight, and the ACA’s importance to the disability community cannot be overstated.”

A decision in the case is not expected until next year.

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