On November 10, the Supreme Court will hear oral arguments in California v. Texas, a case that could invalidate the Affordable Care Act (ACA). Since it was signed into law in 2010, the ACA has provided critical protections to the diabetes community in the United States. Now, a group of 18 states led by Texas are arguing that a single change to the law passed as part of the 2017 Tax Cuts and Jobs Act has rendered the entire law unconstitutional, even though there is no evidence that this was an outcome Congress intended at the time. If the Supreme Court rules in favor of Texas, the entire ACA could be ruled unconstitutional.

Because of the ACA, people with diabetes can no longer be denied coverage or charged a higher premium because of their pre-existing condition, and do not have to worry about hitting a lifetime cap on their coverage. Children and young adults diagnosed with diabetes can stay on their parents’ coverage until they turn 26, which provides a safety net as they establish their lives and transition onto their own health insurance plan. Although the law isn’t perfect, this peace of mind represents a sea change from the pre-ACA world of inadequate or non-existent coverage for people with diabetes who weren’t fortunate enough to have a generous employer-based health insurance plan.

For T1International’s patient advocates, the existence of the ACA allows for a level of assurance, which is crucial given that living with diabetes requires constant care and attention. It is for this reason that T1International opposes efforts to overturn the ACA through the California v. Texas lawsuit.

Despite the assertions of pharmaceutical companies, insulin manufacturer patient assistance programs are not an adequate response to the exorbitant cost of insulin. They offer nowhere near the level of protection that ACA-provided health insurance can offer. Patient Assistant Programs shift or are eliminated at the whims of pharmaceutical companies, and can never provide a long-term solution. Meanwhile, the ACA maintains critical protections patients need to survive.

This should not be a partisan issue — it should be about protecting peoples’ right to health. If the entire ACA is overturned, more people with diabetes will pay more money for their medicine, which will result in more people dying because of insulin rationing. We are in the midst of an insulin price crisis in the United States; research indicates that from 2012 to 2016, the amount a person with type 1 diabetes had to spend in a year on insulin alone nearly doubled. Because of these high prices, one of four Americans with type 1 diabetes has reported rationing their insulin in the last year, and many people have died because they can’t afford the insulin their bodies need every day.

Without the ACA, this suffering will only worsen as people with diabetes, among millions of others, will lose their insurance coverage. This threat will be particularly acute for Black, Indigenous, and brown communities, the LGBTQ+ community, and other marginalized people who already face higher rates of uninsurance, discrimination, and difficulty receiving appropriate care even with the ACA in place.

And as the Senate considers the nomination of Amy Coney Barrett to fill the vacancy on the Supreme Court, T1International is concerned about Judge Barrett’s stance on past cases related to the ACA and how her confirmation could affect the outcome of California v. Texas. Judge Barrett has previously written about her disagreements with the Court’s ruling in National Federation of Independent Business v. Sebelius, the 2012 case where the ACA was upheld in the face of a legal challenge.

Given that the ACA was upheld in this case by a single vote, and that Judge Barrett would fill Justice Ruth Bader Ginsburg’s seat after the latter voted in 2012 to uphold the ACA, we are concerned that Judge Barrett’s confirmation could result in an unfavorable outcome in this new case. If Judge Barrett is confirmed to the Supreme Court, it is T1International’s hope that she remember the devastating impact that overturning the ACA would have for the diabetes community and millions of others, especially during the current pandemic and economic downturn.

While the outcome of this case will not change T1International’s commitment to fighting for #insulin4all, we call on the Supreme Court to rule in favor of the defendants and uphold the Affordable Care Act. For patients with diabetes, our very lives depend on it.