If you’re a resident of the District of Columbia and you qualify for help with your health insurance under the Affordable Care Act, don’t wait, you have until Jan. 31 to enroll in Obamacare. It’s still the law of the land and could benefit you and your loved ones, despite a sad and expected federal court ruling out of Texas that threatens the ACA and health coverage for tens of millions of Americans, yet again.

Eleven states and the District have extended Obamacare enrollment deadlines. Those deadlines have already passed in Virginia and Maryland. So, many in the area — along with the rest of the nation — will have to wait for what might be a while to see how the Texas case, brought by a group of Republican attorneys general and opposed by a group of their Democratic counterparts, gets resolved.

The legal elements of the case may be of interest to lawyers and policy wonks.

But, really, are we, almost a decade later, battling over whether, in the richest nation on the planet, health care is a privilege or a right? After failing in Congress for years and dozens of votes, as well as taking a beating in midterm elections, are Republicans so determined to make well-being a state only for the richest few?

The federal judge in Texas went to an extreme, throwing out all of the ACA as unconstitutional in an action that President Trump cheered. Legal experts have doubts about whether the ruling will stand, and the controversial judge provoked ire for partisanship in his decision.

Just think for a second, though, where the nation goes if the judge’s ruling stands: What happens to the tens of millions of taxpayers who get ACA coverage? What happens to the many who got health care help with Obamacare’s expansion of Medicaid? What happens when insurers no longer are barred from refusing to cover tens of millions of Americans with pre-existing conditions, or when they can cap lifetime coverage, or they have no minimum benefits they must offer? What happens when they no longer must allow parents to keep young people up to age 26 on their policies? What happens when health policies no longer offer preventive or women’s reproductive or maternal health benefits?

Although most of us get health coverage at our workplaces, how long will employers keep any of the aforementioned safeguards or benefits if they’re not part of Obamacare policies available to many?

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, effective, and excellent medical care. This is especially true as medical costs skyrocket, including for hospitalization and prescription drugs, and patients confront daunting choices about ever more complex, uncertain treatments and medications. Medical debt and medical bankruptcy are far too prevalent and persist as great shames of the American health care system, on which we spend more than $3 trillion annually while getting some of the poorest outcomes in the industrialized world.

The ACA isn’t the only answer to myriad problems in the U.S. health care system, but Republicans haven’t proposed anything better, including in areas that most Americans may not grasp that Obamacare affects, including the cost, quality, safety, and efficiency of medical treatment.

We’ll need to do more than keep our fingers crossed that appellate jurists will see not only the legal nonsense but the societal chaos that a Texas judge has opined that he — and the GOP — favors. It’s not a pretty thought, especially after the just completed 2018 midterm grind. The 2020 elections are hard upon us now and voters will need to exercise their democratic privileges and rights, again, on how and what they value in their health and well-being.