The U.S. Supreme Court heard oral arguments Tuesday over Texas v. California, in which the state of Texas argued that the entire Affordable Care Act should be rendered unconstitutional.

This is not the first time the Supreme Court has heard cases brought against the ACA. But it is the first case against the ACA with three Trump Administration appointees: Justices Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett. Barrett, the most junior justice, has been openly critical of the ACA in her legal writings.

President-elect Joe Biden spoke after the hearings, calling the case “cruel and needlessly divisive.”

Texas brought the case arguing that more Texas residents have applied for Medicaid due to the ACA. The Texas Solicitor General Kyle Hawkins argued that this has created an injury to Texas both because it has had to spend money on the increased number of Medicaid recipients and on the paperwork the state has to send out.

Hawkins also argued that because the U.S. Congress eliminated the tax penalty to the individual mandate in 2017, the mandate itself is unconstitutional. Hawkins argued that because the ACA is a law, individuals still apply for insurance because they believe they have to do so, which is placing a burden on state governments. 

Part of what is at stake is the question of if the court rules one part of the law unconstitutional, then the court must decide if it must render the entire law unconstitutional.

The California Solicitor General Michael Mongan called the individual mandate an “inoperative provision” and said “there is no legal command,” for individuals to purchase insurance since Congress eliminated the tax. He also said that while Congress eliminated the tax, it kept all other provisions of the ACA and that attempts in Congress to repeal the ACA have failed. Mongan said that if the court decides against the ACA, 20 million Americans could lose health care coverage in the midst of a pandemic. He said it would also cause regulatory disruption, upend the markets and cost states “tens of billions of dollars during a fiscal crisis.”

Russell Toal, New Mexico Superintendent of Insurance, previously told NM Political Report that repealing the ACA would “disproportionately affect New Mexico more than most states.”

He said that nearly 300,000 would lose Medicaid coverage immediately and an additional 800,000 to 900,000 would lose protections for preexisting conditions.

Related: New SCOTUS conservative bloc could overturn ACA, with big impacts on NM

The court is expected to deliver its decision sometime next year.