How it works: A federal judge ruled in December that the ACA's individual mandate has become unconstitutional, because of the way Republicans zeroed out the penalty for being uninsured. If any Americans needed any more reason to vote this bunch of syphilitic ingrates out of office in 2020, here it is. Millions of people out of insurance. Biosimilars of all kinds left unfunded. All thanks to a Republican vendetta against an originally Republican healthcare plan, which has actually done some good for many of their constituents.Why it matters: A ruling striking down the entire ACA would upend major parts of the health care system. Millions of people would lose their health care coverage, and a host of seemingly unrelated policies — including new experiments in how Medicare pays for care and an entire class of prescription drugs — would also go out the window.