By RICARDO ALONSO-ZALDIVAR

WASHINGTON (AP) — When the Supreme Court weighs the fate of “Obamacare,” arguments will revolve around arcane points of law like severability — whether the justices can surgically snip out part of the law and leave the rest.

But what’s at stake has real-world consequences for just about every American, as well as the health care industry, a major source of jobs and tax revenues. Whether the Affordable Care Act stays, goes or is significantly changed will affect the way life is lived in the U.S.

The argument against the law from the Trump administration and conservative states is that the 10-year-old statute was rendered unconstitutional in its entirety when Congress dialed down to zero a penalty on those remaining uninsured. The court has shifted solidly to the political right under President Donald Trump. Here’s a look at some of what’s at stake if the opponents of the law prevail:

COVID-19 A NEW PRE-EXISTING CONDITION

Before the ACA, insurers could turn a person down for an individual policy, or charge them more, based on their medical history. The nonpartisan Kaiser Family Foundation estimates that about 54 million working-age adults have health issues that would have made them “uninsurable” before former President Barack Obama’s signature law.

Tens of millions more have issues that could have led to higher premiums. Female gender was one, as insurers routinely charged women more.

COVID-19 would become America’s newest pre-existing condition, for more than 10 million people who have tested positive so far.

Under the ACA, a coronavirus case cannot be used to deny someone coverage or charge them more. If Obamacare is gone, that becomes a real question.

Trump promised to always protect people with preexisting conditions, but never said how he’d do it.

COVERAGE FOR MORE THAN 20 MILLION

The ACA’s two main programs for covering uninsured people would be wiped out if the law is overturned, leaving more than 20 million people uninsured unless a divided Congress can put a new safety net in place.

About 12 million low-income people are covered through the health law’s Medicaid expansion, now available in most states. Most of them are adults working in jobs that don’t pay all that much, and don’t come with health insurance. Some have lost jobs in businesses like hotels, restaurants, and movie theaters, which continue to struggle because of the pandemic.

Another group, more than 11 million people, has private coverage purchased through taxpayer-subsidized private markets such as HealthCare.gov

That’s also in jeopardy.

PREVENTION

Most American women now pay nothing out of their own pockets for birth control. That’s covered as a preventive service, free of charge to the patient, under the ACA.

Many other services, from colonoscopies to flu shots, are also free.

If people again face copays for routine preventive care, that may discourage some to go for tests shown to detect diseases like cancer at early stages when they are easier to treat.

RETURN OF A MEDICARE GAP

“Obamacare” took the first major steps to close Medicare’s unpopular “doughnut hole,” a coverage gap that used to leave older Americans on the hook for hundreds of dollars in prescriptions drug costs. Congress later accelerated the timetable.

Repealing the ACA would mean the return of the coverage gap, sure to infuriate older voters, many of whom say their medications still cost too much.

That’s just one of many potential consequences to Medicare. The ACA slowed payments to hospitals and insurers to extend the life of the Medicare trust fund.

LONGER RUNWAY SHORTENED

One of the earliest benefits to take effect after the passage of “Obamacare” was a requirement that insurers allow young adults to stay on a parent’s plan until they turned 26.

That provided a longer economic runway for millions of young adults, who back then were struggling with the lingering effects of the Great Recession. Nowadays it’s the consequences of the coronavirus economy.

Before the ACA’s coverage extension, insurers routinely cut off young adults upon graduation.

TAX CUT FOR THE WEALTHY

“Obamacare” raised taxes on upper income individuals to help finance its coverage expansion.

If the entire law is repealed, that would deliver a tax cut to well-to-do people, many of whom have escaped the economic shock of the COVID-19 pandemic because stock market investors have continued to do well.

POLITICAL RUBIK’S CUBE

Passing the 900-page-plus ACA was a political challenge that took more than a year at a time when Democrats controlled the White House and both chambers in Congress.

Putting together a replacement under a divided government would be the ultimate political puzzle. Neither Democrats nor Republicans agree even within their own ranks what that should look like.

President-elect Joe Biden would build on the ACA by improving it and adding a new public health insurance option. But party liberals want a government-run system for all Americans, including the 160 million covered through employer plans.

Many Republicans, meanwhile, want to scale back the government’s support for health care. They would make deep cuts to Medicaid financing, and leave the ACA’s insurance markets as a state option. Protections for people with pre-existing conditions could be eroded under new rules.

Trump once famously said, “nobody knew health care could be so complicated.” That was in 2017, when he and a Republican-controlled Congress harbored hopes they could “repeal and replace” the ACA.

It didn’t happen then because Republicans could never agree on what a replacement would look like.

Fast forward to 2020. Health care has only gotten more complicated.

By LINDA A. JOHNSON and LAURAN NEERGAARD

Pfizer said Monday that an early peek at the data on its coronavirus vaccine suggests the shots may be a surprisingly robust 90% effective at preventing COVID-19, putting the company on track to apply later this month for emergency-use approval from the Food and Drug Administration.

The announcement, less than a week after a presidential election that was seen as a referendum on President Donald Trump’s handling of the crisis, was a rare and major piece of encouraging news lately in the battle against the scourge that has killed more than 1.2 million people worldwide, including almost a quarter-million in the United States alone, with confirmed infections in the U.S. expected to eclipse 10 million on Monday.

“We’re in a position potentially to be able to offer some hope,” Dr. Bill Gruber, Pfizer’s senior vice president of clinical development, told The Associated Press. “We’re very encouraged.”

Dr. Anthony Fauci, the government’s top-infectious disease expert, said the results suggesting 90% effectiveness are “just extraordinary,” adding: “Not very many people expected it would be as high as that.”

“It’s going to have a major impact on everything we do with respect to COVID,” Fauci said.

Pharmaceutical companies and various countries are in a global race to develop a vaccine against the virus. Fauci said that the Pfizer vaccine and virtually all others in testing target the spike protein the coronavirus uses to infect cells, so the results validate that approach.

Monday’s announcement doesn’t mean a vaccine is imminent: This interim analysis, from an independent data monitoring board, looked at 94 infections recorded so far in a study that has enrolled nearly 44,000 people in the U.S. and five other countries. Some participants got the vaccine, while others got dummy shots.

Pfizer Inc. did not provide any more details about those infections and cautioned that the initial protection rate might change by the time the study ends. Even revealing such early data is highly unusual.

Authorities have stressed it’s unlikely any vaccine will arrive much before the end of the year, and initial supplies will be rationed.

“We need to see the data, but this is extremely promising,” said Dr. Jesse Goodman of Georgetown University, former chief of the FDA’s vaccine division. He ticked off many questions still to be answered, including how long the vaccine’s effects last and whether it protects older people as well as younger ones.

If Pfizer’s vaccine ultimately pans out, “it’s going to be a while before this has a major impact at the population level,” Goodman said.

Marylyn Addo, head of the tropical medicine unit at UKE hospital in Hamburg, Germany, said the interim results were “an interesting first signal,” but questions remain.

Global markets, already buoyed by the victory of President-elect Joe Biden, exploded on the news from Pfizer. Major markets in Europe, where infections have soared, were up 5%. In the U.S., the S%P 500 surged 3.7% after the opening bell, and the Dow Jones Industrial Average was up more than 1,300 points.

Trump, who had suggested during the presidential campaign that a vaccine could be ready by Election Day, tweeted on Monday: “STOCK MARKET UP BIG, VACCINE COMING SOON. REPORT 90% EFFECTIVE. SUCH GREAT NEWS!”

The timing is likely to feed unsubstantiated suspicions from Trump supporters that the pharmaceutical industry was withholding the news until after the election. Donald Trump Jr. tweeted: “The timing of this is pretty amazing. Nothing nefarious about the timing of this at all right?”

Pfizer Chairman and CEO Albert Bourla said on CNBC that the election was always an artificial deadline and that the data was going to be ready when it was ready. The independent data monitors met on Sunday, analyzing the COVID-19 test results so far and notifying Pfizer.

“I am very happy,” Bourla said, “but at the same time, sometimes I have tears in my eyes when I realize that this is the end of nine months, day-and-night work of so many people and how many people, billions, invested hopes on this.”

He added: “I never thought it would be 90%.”

Earlier this year, Fauci said he would be happy with a COVID-19 vaccine that was 60% effective. Scientists have warned for months that any COVID-19 shot may be only as good as flu vaccines, which are about 50% effective and require yearly shots.

The coronavirus shots, made by Pfizer and its German partner BioNTech, are among 10 possible vaccine candidates in late-stage testing around the world — four of them so far in huge studies in the U.S. Another U.S. company, Moderna Inc., also has said it hopes to be able to file an application with the FDA later this month.

Volunteers in the final-stage studies, and the researchers, don’t know who received the real vaccine or a dummy shot. But a week after their second required dose, Pfizer’s study began counting the number who developed COVID-19 symptoms and were confirmed to have the coronavirus.

Because the study hasn’t ended, Gruber couldn’t say how many in each group had infections. But the math suggests that almost all the infections counted so far had to have occurred in people who got the dummy shots.

Pfizer doesn’t plan to stop its study until it records 164 infections among all the volunteers, a number that the FDA has agreed is enough to tell how well the vaccine is working. The agency has made clear that any vaccine must be at least 50% effective.

No participant so far has become severely ill, Gruber said. Nor could he provide a breakdown of how many of the infections had occurred in older people, who are at highest risk from COVID-19.

Participants were tested only if they developed symptoms, leaving unanswered whether vaccinated people could get infected but show no symptoms and unknowingly spread the virus.

FDA has told companies they must track half their participants for side effects for at least two months, the time period when problems typically crop up. Pfizer expects to reach that milestone later this month, but said Monday no serious safety concerns have been reported.

Because the pandemic is still raging, manufacturers hope to seek permission from governments around the world for emergency use of their vaccines while additional testing continues — allowing them to get to market faster than normal but raising concerns about how much scientists will know about the shots.

The FDA’s scientific advisers last month said they worry that allowing emergency use of a COVID-19 vaccine could damage confidence in the shots and make it harder to ever find out how well they really work. Those advisers said it’s critical these massive studies are allowed to run to completion.

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AP writers Frank Jordans and Charles Sheehan contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.