The US Supreme Court considers President Barack Obama's Affordable Care Act on 10 November.

There are tens of millions of Americans whose access to healthcare could drastically change as a result of their ruling.

Allie Marotta has heard the tales of people giving up their dreams in exchange for a job which provides health insurance.

After the pandemic hit, she's struggled with work, but is still able to access health coverage.

Marotta says when she aged off her parents' coverage in December, she couldn't afford to pay for the plans she qualified for under the ACA?

The ACA brought health insurance coverage to millions of Americans when it was signed into law back in 2010.

The Supreme Court will rule on whether the act's individual mandate that everyone must buy health insurance is in line with the Constitution.

If it's the latter, protections for patients with pre-existing conditions, federal subsidies and aid expansions for lower-income Americans are also gone.

It's also been unpopular among already-insured Americans who saw their coverage costs rise as sicker individuals were added to the pool.

Out of the 23 million Americans who are currently insured by the ACA or expanded Medicaid programmes, 21 million could lose their insurance if the act is overturned.

And the backdrop to all this - a global pandemic that's affected more than 7.5 million Americans.

Given the damage Covid-19 can do to the body, and the unknown number of related complications it may cause survivors, contracting the virus in 2020 could become a pre-existing condition in the eyes of insurers down the road.

On the ACA now, it costs Ziolko, whose preferred pronouns are they/them, a week's pay each month for insurance that ensures they have access to the doctors and prescriptions they need to treat long-term kidney problems and bipolar disorder.

Ziolko says the ACA allows them to have insurance - but it means a lot more than that.

A Kaiser Family Foundation (KFF) analysis found that as of 2018, nearly 54 million non-elderly adults in the US have pre-existing health conditions that would have made them uninsurable before the ACA?

A 2017 government study reported about 133 million Americans under age 65 would have to pay extra for insurance coverage - or be denied outright - due to a pre-existing condition if the ACA is overturned?

While President Trump has promised to protect pre-existing conditions in particular, his justice department has been arguing in court that the entire ACA ought to be overturned.

Trump did sign an executive order to safeguard pre-existing conditions, but a policy statement - even if it's from the president - doesn't legally bind insurance companies.

While her father was working, health coverage wasn't a concern.

Her asthma would count as a pre-existing condition in a post-ACA world.

Six in ten Americans say they or a member of their family have a pre-existing condition?

But pre-existing condition protections are backed by both party supporters and independents.

Backtracking to protect industry profits while removing the penalties on healthy people and then trying to keep those with pre-existing conditions covered, she says, isn't feasible.

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