ST. PAUL — A federal appeals court in New Orleans on Tuesday, July 8, is set to take up a case that could have profound effects on health care access around the country, including on coverage provided to millions of Minnesotans.

The U.S. Fifth Circuit Court of Appeals is set to consider the minimum essential coverage provision of the Affordable Care Act, also known as the individual mandate. The provision of the law enacted in 2010 said that people must have some level of health insurance coverage or face a financial penalty.

Republican leaders in 20 states led by Texas filed the lawsuit in 2018, arguing that because the individual mandate is key to the ACA, but is no longer required to be enforced, the entire Affordable Care Act is unconstitutional and should be struck. North Dakota and South Dakota are among those opposing the ACA.

In December, a Texas judge ruled in favor of the 20 states challenging the health care act, saying the entire ACA was invalid. And the Trump Administration has sided with the Republican-led states that the ACA should be found unconstitutional.

Minnesota is among 17 states defending the Affordable Care Act in the case. And Minnesota Democrats U.S Sen. Tina Smith, U.S. Reps. Angie Craig and Dean Phillips, as well as Minnesota Attorney General Keith Ellison, reiterated their support for the law during a conference call with reporters.

"Tomorrow, instead of defending the Affordable Care Act, the Trump administration will be arguing to overturn this law," Smith said. "And today, we want to make clear what would happen if President Trump gets what he wants."

The impact, they warned, would be a largescale loss of affordable coverage for Minnesotans with pre-existing conditions, hundreds of thousands of people in the state could lose insurance coverage, including more than 200,000 who gained coverage under Medicaid expansion and insurers could decide not to cover essential benefits like mental health treatment and prescription drugs.

"It's very serious, the consequences are very serious to Minnesotans and Americans," Ellison said. "It is absolutely essential that we win this lawsuit. We cannot go back to the days where people are denied healthcare because of a pre-existing condition."

Dawn Burnfin, a Chisholm home health care worker and mother of five children with Ehlers-Danlos Syndrome, an inherited disease that affects skin and joints, said she couldn't imagine having to pay for hospital visits if her children were denied insurance coverage for their condition. Burnfin said she has very little in savings now and that likely would be blown if the ACA were overturned without a replacement.

“What I have, I don’t want to lose because I can't pay a hospital bill because my child has once again sprained a joint or hurt themselves,” Burnfin said. “And I don’t want that for anybody else either.”

Opponents of the ACA have said overturning the law would give lawmakers a chance to pass a proposal that imposes lower health insurance rates on those who don't receive insurance coverage through their employer or to give states additional flexibility to create insurance marketplaces that better fit their unique needs.

Congress has been unable to agree on such a plan or on various reforms to the ACA since it passed nearly a decade ago.