Up to 130 million Americans are at risk of losing health insurance protections for pre-existing conditions. This is a terrifying prospect to me as a family physician, and as someone whose own family might fall through the pre-existing conditions cracks without the protections built by the Affordable Care Act.

After I finished training at Maine Medical Center but before coverage through my employer-based health insurance began, we bridged the gap with a family plan through the ACA marketplace. It was just going to be for peace of mind for the summer. After all, we were healthy. Right?

Then we had the summer from hell. It turned out my wife, her mother who lives nearby and I all had tumors growing inside.

Fortunately, the growth in my leg turned out to be a rare benign mass that a skilled surgeon promptly removed. In a grim coincidence, though, my wife and her mother were themselves diagnosed with breast cancers. Our terrified family shuffled through surgery, radiation, chemotherapy and a blur of sleepless nights and dazed days. We made vain attempts to convince our 5- and 7-year-old daughters that, no, all the people they love are not about to get cancer and die. It was an emotional free fall.

But at least we had health insurance. Moreover, the protections for pre-existing conditions prevented my new employer-based insurer from denying coverage.

We attended weekly support groups with other families from across the socioeconomic and political spectrum. Listening, I developed a more personal understanding of how health insurance matters. Those without health insurance and those with high-deductible plans had the lurking prospect of family financial ruin exacerbating the primal fears of illness and death.

Caregivers and breadwinners lived in fear of losing their jobs, and their employer-based health insurance, because they were missing work to care for their sick partners and still-needy children. Uncertainty is salt poured in the wound of medical misfortune.

Recent events could heap a hefty dose of additional uncertainty in the form of lost coverage or lack of insurability due to pre-existing conditions. The threat arises from a legal case that the 5th U.S. Circuit Court of Appeals is considering. A lower federal court ruled the entire ACA unconstitutional because the tax law passed in late 2017 erased the tax penalty for avoiding health insurance.

This legal uncertainty contradicts Sen. Susan Collins’ assertion in a Press Herald op-ed published after the tax bill passed that her support of the measure would not threaten anyone’s health insurance. Some legal experts anticipate the 5th Circuit will overturn the lower court’s ruling – thus sustaining the ACA – but that outcome is not certain.

How many Mainers could this affect? The nonpartisan Kaiser Family Foundation found that 26 percent of adults ages 18-64 in the Portland metropolitan area have deniable pre-existing conditions such as diabetes, congestive heart failure, emphysema and cancer.

Furthermore, losing protections for pre-existing conditions would hinder Maine’s efforts against the opioid crisis. Substance use disorder is a deniable pre-existing condition, so undermining ACA protections could worsen this devastating problem. Maine already is one of the most drug-affected states in our country; erecting barriers for those most in need of care could make it worse.

In our household, we are incredibly grateful that my wife and her mother fared well in treatment and are thriving.

We thank the dedicated doctors, nurse practitioners, nurses, pharmacists, counselors and other professionals and volunteers who helped us survive that summer and the year that followed. And we appreciate the marketplace health plan that braced us against catastrophe.

Those were times of terror, and it is a relief to be past them. If the ACA’s protections are removed, however, we may have to face the new fear that comes with the label, “disqualifying pre-existing condition.”

Sam Zager, M.D., of Portland is a family physician and a member of Maine Providers Standing Up for Healthcare.