After the Supreme Court listened to arguments on the King vs Burwell case March 4, the fate of millions of people is in their hands. People like Delma Limones, 22, a college student from Austin, Texas, who has health insurance for the first time in four years as a result of the ACA. For Delma, the health insurance issue hits home in more ways than one. Thanks to a financial subsidy like the ones being targeted by this case, she was not only able to obtain health insurance for herself, but to get treatment for her ailing mother as well. "For the first time in four years," said Ms. Limones, "I have a sense of security because I don’t have to choose among rent, educational expenses, or a visit to the doctor." Her mother was not as lucky. She was uninsured when she got cancer, as Delma recounts, which could have been prevented had she been insured at the time.

According to a new report by Planned Parenthood, of the 9.3 million people at risk of losing financial assistance, about one-third (3.2 million) are people of color, including 1.5 million Latinos and 1.2 million African Americans. Another 495,000 individuals in other communities of color would lose premium subsidies and access to affordable coverage if the Court ruled in favor of King. This includes over 4 million women — including 1.4 million women of color — who, like Delma and her mother, have enrolled in affordable Marketplace coverage in 34 states.

"These are just today's numbers, but it would get much worse if the Supreme Court ruled the wrong way," said Cecile Richards, president of Planned Parenthood Action Fund. "There would continue to be a lasting, negative impact for generations if the promise of affordable health insurance is stripped away." The wrong ruling would adversely impact low income households in the 34 states that don’t have their own state-run exchanges and thus depend on federally run marketplaces. As a consequence of not having access to these subsidies, those affected will no longer be able to afford basic health services such as routine doctors’ visits, affordable birth control, maternity care, cancer screenings, and other preventive care.

This scenario would also put into question the viability of health insurance markets in the 34 affected states, as it would eliminate billions in tax credits and cost-sharing reductions. It would also wreck havoc in the health insurance industry itself, potentially prompting a market death spiral and, for some insurance companies, even insolvency, as millions of healthy people would be driven away from seeking coverage.

Opponents of the Affordable Care Act claim that the law limits federal health insurance subsidies to states that actively established their own insurance exchanges while it penalizes those that opted out. Though their claims about the law have been debunked and dismissed as politically motivated, the justices will now have to decide on the legality of these subsidies. Their decision, which is expected to come in June, could literally mean the difference between life or death to Latinos and other minorities who rely on these subsidies for coverage. According to Kaiser, 95 percent of Latinos qualify for subsidies on the marketplace or Medicaid, and a quarter live in states that didn’t expand Medicaid. This means millions could be left to fend for themselves when it comes to health insurance, the very problem the Affordable Care Act intended to solve.

Advocates hope that the highest court of the land sides with the seventy-one percent of voters who, according to a new report from the Service Employees International Union (SEIU), want the Supreme Court to decide in favor of continuing this much needed financial assistance. "We hope the Supreme Court upholds the law in this case and maintains the coverage that is helping millions of people get preventive health care," concludes Mrs. Richards. Until their decision comes in June, millions of people will be holding their breath. We can only hope the outcome doesn't make them pass out.