The battle playing out in our federal courts will determine whether health insurance companies could once again be able to reject you for insurance coverage simply because you have a preexisting condition. The attorneys general of 18 states, including North Dakota, filed a suit in federal court alleging that the Affordable Care Act, which contains those protections, violates the Constitution. A federal judge in Texas has ruled that the law was unconstitutional. I am well aware they went “judge shopping” and got the Texas judge that they wanted for this case. That ruling was appealed.

The case was argued last month in the United States Court of Appeals for the Fifth Circuit. Then in a nearly unheard of government twist, the Justice Department refused to support the constitutionality of the law in the court proceedings, presumably at the request of the Trump administration. This litigation will now almost certainly go to the Supreme Court, where the newly selected majority of President Trump will then issue its verdict.

If the Supreme Court rules the Affordable Care Act unconstitutional, then make no mistake, the private health insurance companies will be able to once again to deny insurance coverage to those people with preexisting conditions. The Republicans in Congress have tried more than 60 times to repeal the Affordable Care Act. Even though the Republicans now claim to support the specific provision dealing with preexisting conditions, they have no replacement plan that will keep those key protections in place.

For decades, Americans had to live with the reality that if they had a preexisting condition, they would either be rejected for an insurance policy or offered a plan designed to be unaffordable. That all changed with the passage of the Affordable Care Act. But the provision dealing with preexisting conditions, along with other important and popular changes in the Affordable Care Act, will vanish if the lawsuit succeeds.

The provision that allows parents to keep their children on their insurance policy until age 26 has been very important to millions of Americans. The provision I championed that bans lifetime limits on insurance policies has also been a godsend for many families. These are only some protections that will be extinguished if the Republicans are successful in repealing the Affordable Care Act or if the Supreme Court declares it unconstitutional.

The Republicans have already done major damage to the Affordable Care Act by eliminating the requirement that all Americans must have health insurance. Unless everyone is in the insurance pool, the provision for preexisting conditions will be unaffordable. When they eliminated the individual mandate, they took the first significant step toward eliminating the crucial protections given those people with preexisting conditions.

There is much debate these days about a new approach to the health care issue. Many Democrats are calling for “Medicare for All.” I do not believe that is going to happen for two basic reasons. First, I do not believe it is affordable. Second, many Americans get their health insurance from their own employers. A “Medicare for All” approach would prevent them from receiving that benefit at their workplace. That makes little sense to me.

Let us fix and improve the Affordable Care Act. The Trump administration has taken many actions to weaken it. The Kaiser Family Foundation has already estimated that the premiums this year are up to 16 percent higher than they would be without the reckless Republican policies, including the repeal of the individual mandate. The structure of the Affordable Care Act remains sound. Policymakers should fix it, add a public option, and make sure that all Americans, including those with preexisting conditions, can access and afford the kind of health care they need over the long term.

Byron Dorgan served in Congress as senator and representative from North Dakota. He is now a senior policy adviser and chairman of the government relations practice at Arent Fox. You can find him on Twitter @ByronDorgan.