From Alaska to Maine, and California to Virginia. Across a wide array of blue states, purple states, and yes, even several red states, 17 million low-income Americans gained access to health care in the past five years. Yet, even with overwhelming evidence of the benefits to patients, providers and taxpayers, it may all be at risk.

Why is health care for the 17 million that gained access through Medicaid expansion at risk?

Attorneys general in nearly 20 states, joined by the Trump administration earlier this year, have made invalidating the entirety of the Affordable Care Act their mission. Having failed in Congress to repeal the Affordable Care Act, its opponents embarked on what at first appeared to be a quixotic legal journey.

‘Success’ for plaintiffs in the Texas lawsuit would also result in a rollback of Medicaid expansion in its entirety. With no plan in place as a backup, those benefitting from Medicaid expansion would rejoin the ranks of the uninsured – forced to pay for health care coverage out of pocket, or forego care altogether.

How has Medicaid expansion really helped?

In myriad ways. Here are but a few. Medicaid expansion has been shown to boost coverage, improve access to care and increase financial security, offering economic and health benefits to individuals and families, as well as providers, hospitals, and entire communities and states.

In states that have expanded Medicaid the uninsured rate has fallen, not just for urban areas, but rural communities as well. Since passage of the ACA in 2010 and the expansion of Medicaid in 2014, the uninsured rate in rural areas has fallen to 7.6 percent in states that expanded – a full 8 percentage points lower than those that did not. Medicaid coverage allows people in rural communities to seek out preventive care, including screenings, vaccinations or visits to the doctor rather than trips to the emergency room that often fail to address more complex health conditions and contribute to the high cost of care.

If Medicaid expansion were to go away, we know how the story will end. ER visits will go up. Medical bankruptcies will go up. Uncompensated care costs will go up. Hospitals, especially those in rural communities, will close. Local jobs and development will suffer alongside the hospitals. Communities will suffer.

On July 9, the 5th Circuit Court of Appeals heard oral arguments in Texas v. United States. While we can’t project the outcome, it appears this case is destined for the Supreme Court, where the ACA prevailed before, though under a different composition.

With a recent rightward shift in the Supreme Court, it’s unclear the ACA’s ultimate fate. Yet one thing remains crystal clear: Medicaid expansion has made millions of people’s lives better. Building on the fundamental promise of Medicaid 54 years ago, Medicaid expansion serves as a critical lifeline for low-income people and their families. It will continue to be the most important health program to lift people out of poverty and ensure that their health needs are met.

This August, we encourage you to reach out to your elected officials, and tell them why Medicaid expansion and the ACA are important to you. Need some help? Let us know! We can, and will, prevent this latest act of sabotage.