The Affordable Care Act (ACA) has been a contentious policy since it was introduced. Often referred to as Obamacare, this policy expands the availability of affordable health insurance. Recently, Texas, Wisconsin, and 18 other conservative states have filed a lawsuit hoping to overturn the ACA altogether. Although most people are aware of the impact this would have on healthcare, most people don’t know that the ACA also provides billions of dollars to support public health organizations.

This case, known as Texas v. Azar, was filed in February 2018 by Texas and 19 other Republican states. What makes it different from any of the other attempts that have been made to get rid of the ACA? Last year, Congress got rid of the tax penalty imposed on people who do not have health insurance, but the actual mandate to buy insurance remains. Now that the mandate is not a tax, Republicans are arguing that it is an unconstitutional abuse of power and the entire ACA must be repealed. Significantly, the Trump administration has explicitly stated that they will not be supporting some key aspects of the ACA. This lack of support from the administration does not help the ACA’s case.

Repealing the ACA would have huge impacts, not only on healthcare but also on the funding provided for public health projects. The ACA established the Prevention and Public Health Fund, which accounts for 12% of the total program funding for the U.S. Centers for Disease Control and Prevention (CDC). Over $324 million of this funding goes toward the CDC’s immunization program yearly, which works to fight infectious diseases through detection, prevention, and response. Immunization programs are extremely effective initiatives, preventing 322 million illnesses and saving over $1.3 trillion in societal costs over the last 20 years. Forty percent of the current immunization program is funded by the Prevention and Public Health Fund, and a budget cut this large would severely impact the CDC’s ability to protect Americans from disease threats. Other programs funded by the PPHF include prevention of lead poisoning, Alzheimer’s research, chronic disease management, and countless others. All Americans are affected by the ACA’s public health funding.

There is much uncertainty regarding the outcome of Texas v. Azar. Some analysts claim that the Republicans’ plan has no chance of working due to the jump in reasoning between the mandate and a repeal. However, the 2012 Supreme Court case against the ACA made it very clear that the mandate would be unconstitutional without an individual tax.

The potential of Texas v. Azar to travel to the Supreme Court is particularly worrying. According to Dr. Dan Arnold, a postdoctoral fellow at UC Berkeley, “If it does get to the Supreme Court, there’s probably a better chance that Republicans succeed than there would have been a couple years ago, given that Trump has appointed two Supreme Court justices in the last two years, Gorsuch and Kavanaugh.” Many Democratic senators agree, voicing concern that the president is trying to accomplish what he could not initially do through Congress.

Why should we be worried about the removal of these programs in the first place? Public health funding is already being reduced yearly, with the Prevention and Public Health Fund’s total funding being cut by over $6 billion in 2012 and $3.5 billion in 2016. A removal of the ACA without the establishment of another program would result in additional cuts of $5 billion over the next five years on the local, state, and federal levels.

We cannot afford to keep cutting these essential programs, as it is estimated that every 10% increase in funding reduces preventable deaths by 1% to 7%. In terms of the ACA, there is so much more than just health insurance at stake.