ObamaCare's future uncertain as it goes back on trial: What to know

The fate of the Affordable Care Act is once again in limbo, as a federal appeals court in New Orleans weighs the constitutionality of one of the biggest legislative accomplishments of the Obama administration.

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On Tuesday, the U.S. Court of Appeals for the Fifth Circuit is set to hear oral arguments in the case of Texas v. Azar, a suit spearheaded last year by 20 Republican-leaning attorneys general (led by Texas Attorney General Ken Paxton) and endorsed by President Trump.

They argued that because the individual mandate, the ACA tenet that required Americans to either purchase health insurance or pay a fine, was repealed by the 2017 tax overhaul, the law was no longer constitutional. The Supreme Court initially upheld the ACA because of the individual mandate; although Congress does not have the power to require people to buy health insurance, that particular provision was considered part of lawmakers’ taxing authority.

The hearing comes in the wake of a 2018 ruling by U.S. District Judge Reed O’Connor in Fort Worth, Texas, who struck down the law as unconstitutional because Congress rolled back the individual mandate. O’Connor is a conservative Republican and has previously blocked other policies implemented under former President Barack Obama.

Any kind of ruling by a panel of three judges is likely to send the health care law to the Supreme Court, possibly in the midst of the 2020 presidential election. Scheduled to hear Tuesday’s arguments are 5th Circuit Judges Carolyn Dineen King, Jennifer Walker Elrod and Kurt Engelhardt -- two of whom are Republicans.

The ultimate outcome of the lawsuit will affect millions of Americans, and the repeal of the nine-year-old law could leave up to 32 million people without health insurance by 2026, according to a Congressional Budget Office report from 2017 about the effects of repealing the ACA.

Premiums for policies purchased through marketplaces or directly from insurers, meanwhile, would likely increase by 20 percent to 25 percent in the first year of the new plan, following the enactment, according to the CBO. By 2026, the increase is expected to climb to 50 percent following the elimination of the Medicaid expansion. Average premiums would also likely spike as a result.

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Repealing the ACA has been a long-standing goal of Trump and Republicans, but they failed to do so in 2017 when the Senate narrowly missed the necessary number of votes.

On Friday, California Attorney General Xavier Becerra -- who is leading a coalition of 20 blue states in defending the ACA -- argued that the removal of the individual mandate did not invalidate the law.

"Our argument is simple," Becerra said in a statement. "The health and wellbeing of nearly every American is at risk. Health care can mean the difference between life and death, financial stability and bankruptcy. Our families' wellbeing should not be treated as a political football.”