The Supreme Court plans to hear a case contesting federal health insurance subsidies for Americans who aren’t covered by employers or Medicaid, including hundreds of thousands of Latinos who signed up for health care plans through the federal marketplace.

The law subsidizes plans for eligible Americans who go through their state’s health care exchange. However, just 12 states have their own exchange to go through, leaving residents in most states to rely on HealthCare.gov and federal subsidies, including in Pennsylvania. Policymakers and courts alike haven’t agreed on whether those Americans are eligible for federal subsidies. The law’s challengers point to the language in the Affordable Care Act specifying that tax credits are eligible “through an exchange established by the state.”

In July, two separate U.S. appellate courts released opposing rulings. The D.C. Circuit Court pointed to the language, while the Richmond Circuit Court pointed to pizza. Judge Andre Davis argued that it doesn’t matter where the pizza comes from — if you asked for ham and pepperoni from Pizza Hut, but said you were fine with Dominos, then a ham and pepperoni pizza from Dominos still fits the order. In his metaphor, 37 states, including Pennsylvania, don’t have any Pizza Huts. In September, the D.C. Court withdrew it’s opinion, leaving the pizza logic as the reigning decision. That is, until the Supreme Court announced that it’d take on the case. If it had declined the case, then federal subsidies would have remained legal.

With the second wave of open enrollment beginning Nov. 15, the Supreme Court’s decision could have major implications for Americans throughout the country, including in states like Pennsylvania that haven’t set up a state-run marketplace. Without a subsidy, the average monthly premium could increase from $69 to $345. Affordable Care Act supporters worry that if the Supreme Court dismantles federal subsidies, more than 4.7 million Americans will see their rates increase and consider dropping their plan. The price hike would likely deter even more Americans from enrolling, undermining the core of the health care law.