Editor’s note: This is part of an ongoing series highlighting the local impact of Trump’s policies in key counties in MI, PA, WI, and FL.

If successful, an ongoing lawsuit winding its way through a federal appeals court — and greenlit by the Trump Administration — could rip apart the entire Affordable Care Act, potentially leaving millions of Americans without health care at all.

That includes thousands of Monroe County, Florida, residents who rely on the Affordable Care Act to help foot the heightened costs of health care expenses that have steadily risen under President Trump’s first term.

In the 2019 open enrollment period, over 8,000 Monroe County residents enrolled in a health insurance plan in the ACA Marketplace. In 2018, more than 1,500,000 Florida residents were enrolled in an ACA Marketplace plan.

And of the 1.5 million Floridians enrolled, 94% received premium subsidies and 64% received cost sharing subsidies to help curb the cost of out-of-pocket expenses. Those subsidies stand to disappear if the Trump-approved lawsuit is successful.

Between 2010 and 2016, the Affordable Care Act saved Florida Medicare enrollees over $1.7 million in discounts for prescription drugs such as insulin, the prices of which have steadily risen under Trump’s first term — despite his emphatic campaign promises to lower prescription drug prices as president.

In Monroe County, nearly 7,500 out of the 8,000 residents enrolled in a Marketplace plan received premium discounts or cost sharing reduction subsidies.

If this lawsuit is successful, many of these Floridians could see their health coverage — and the cost saving benefits it provides — suddenly ripped away.

The lawsuit was filed in 2018 by a group of 18 Republican attorneys general and 2 Republican governors, after the Trump Administration attempted — and failed — to push a full repeal of the Affordable Care Act through Congress. It is being considered by a panel of three judges — two of whom are Republicans — on the 5th U.S. Circuit Court of Appeals.

Despite congressional failures, in March 2019, the Trump Justice Department filed a legal brief in support of this potentially catastrophic lawsuit.

Trump’s continued push to gut the Affordable Care Act serves as a complete reversal of his many — and now broken — pledges on the campaign trail not to eliminate coverage. “We’re going to have insurance for everybody,” Trump said in an interview days before his inauguration in January 2017. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

The verdict reached by this lawsuit will make or break crucial components of the law, including regulations protecting people with pre-existing conditions and the ACA’s Medicaid expansion, which covers approximately 12 million Americans.

“Remember that the kinds of provisions here that would be struck down if there’s no severability are, for example, the provision about when you can be denied or charged more insurance for preexisting conditions,” said Attorney Douglas Letter who argued on behalf of keeping the Affordable Care Act in a July 2019 hearing.

In 2015, an estimated 3.1 million Floridians had a pre-existing condition that could have prevented them from receiving health insurance coverage before the Affordable Care Act became law.

Monroe County served as an essential swing region that helped deliver Trump the Sunshine State in the 2016 presidential election, after previously supporting Barack Obama. It remains unclear whether Monroe County will swing the president’s way again in 2020 as he continues his potentially catastrophic assault on the health insurance coverage depended upon by so many of its residents every day.