A legal ruling handed down Wednesday created massive uncertainty about the Affordable Care Act’s future. But the consumer subsidies and other reforms established by the landmark health law, such as protections for people with pre-existing conditions, remain in place for now.

Whether the same will be true a year from now is lamentably up in the air, creating uncertainty for the 20 million Americans who have come to rely on the law to cover themselves and their families.

The Affordable Care Act, which already has survived two constitutional challenges fought all the way to the U.S. Supreme Court, faces a third legal threat to its existence. This latest lawsuit is led by attorneys general for Texas and other Republican-leaning states. They argue that the entire law must be scrapped because its “individual mandate” to buy health insurance no longer is enforceable after Congress reduced the financial penalty to $0 in 2017.

Those who have followed ACA legal battles understandably feel exasperated. The first lawsuit mounted by the ACA’s opponents contended it was unconstitutional because of the requirement to buy insurance. Now, this latest challenge contends the entire law must be struck down because it essentially lacks a mandate to buy insurance.

A judge in the Northern District of Texas bought this dubious argument in late 2018. The decision was appealed quickly. Both the law’s proponents and opponents have waited for months for a ruling from the 5th Circuit in New Orleans. A three-judge panel finally ruled on Wednesday while the historic debate over impeaching President Donald Trump played out in Congress. In a 2-1 vote, the panel essentially agreed with the lower court, but then kicked the case back to the district court judge to have him decide which parts of the law should be thrown out.

The ruling’s timing puts it at risk of being overshadowed by the drama in Washington, D.C. But the nation can ill afford to simply set this aside. Overturning a law that’s been in place for nearly a decade would result in serious disruption of the nation’s health care system. What would happen to the nearly 13 million low-income Americans who became newly eligible for Medicaid coverage under the ACA? How would families who rely on the ACA’s subsidies to buy insurance continue to afford it? Would there be another program to help seniors who found prescription drug cost relief through the ACA’s closure of the Medicare “doughnut hole”?

Other popular reforms tied to the ACA’s fate: keeping young people on parents’ insurance plans until age 26, and eliminating out-of-pocket preventive care costs. Enhanced federal funding for state programs are also at risk.

The ACA is in real jeopardy. Those who put it at risk owe the nation a serious game plan to clean up the mess they worked to create.

Star Tribune, Minneapolis