For most Americans, the Supreme Court's ruling next week on President Obama's health care law will be an academic exercise with political fallout -- but not personal implications.
For millions of people, however -- some young, some old, some sick -- the law is already affecting their pulse rates and pocketbooks, and a decision to strike it down could come with a medical or financial cost.
Among the decisions the justices might render, such as upholding the law or striking down the mandate that most Americans get health insurance, tossing out the entire law could have the greatest impact.
That's because the law's Democratic authors purposely ensured that many popular provisions, such as covering young adults, would kick in first.
While some insurers have said they would keep that and other provisions, a court ruling that strikes down the law would eliminate both its legal basis and its funding.
"I'm just devastated that they could throw that out," says Judy Lamb, a cancer patient in Golden, Colo. "There are just so many people that need it -- people like me."
Lamb, 59, has benefited from the law's ban on lifetime limits in health insurance policies. After battling breast cancer that spread to her bones and liver, she was close to hitting the $2 million limit on her husband's employer-provided plan.
Two of her children, 25 and 23, have taken advantage of the law's provision that enables young adults to stay on their parents' policies until they turn 26.
That's important to people such as Steven Giallourakis, who turns 22 next month. The Cleveland resident has been in and out of college while dealing with leukemia; at 19, he was forced to return to school soon after a bone marrow transplant, just to get health coverage.
Like Lamb, Giallourakis came close to his $2 million lifetime limit. Now he's hoping to complete college and choose a job based on interest, not insurance.
"I'm praying that it doesn't get thrown out," he says.
In Chicago, Dan Morgridge has been helped by a provision of the law that created a temporary high-risk insurance pool for people who had pre-existing conditions for at least six months.
Morgridge, 28, spent years uninsured until severely injuring his knee, which required physical therapy. Fearing expensive surgery, he joined the law's temporary high-risk insurance pool.
As a result, he pays $192 a month and a $500 deductible, but his co-payments are capped at $2,850. Without the law, he might be unable to get insurance at all.
Perhaps the biggest group of beneficiaries under the law thus far are Medicare recipients with high prescription-drug bills who fall into their plans' temporary coverage gaps. The law is gradually reducing the amount they have to pay.
Helen Rayon is among them. At 72, the Philadelphia woman was paying about 75% of the cost for her diabetes medicines -- money that "could have paid for the gas for my car." Now she gets a 50% discount. She also takes advantage of free annual wellness exams and preventive screenings in Medicare.
Small-business owners are cashing in on the law's tax credits. In Chattanooga, Tenn., John Sweet used them to offer health coverage to all 25 employees at Niedlov's Breadworks, rather than just the managers.
If the law is killed, Sweet says he won't renege on that deal. "I don't want to take a step backward," he says.
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