Biden vowed on Tuesday to work with Congress to “dramatically ramp up health care protections” and “get Americans universal coverage.” He also reiterated campaign pledges to tackle the prescription drug costs and expand coverage to the millions of uninsured people — a group that's grown significantly during the pandemic and economic crash.

“I promise you this beginning on Jan. 20, the Vice President-elect Harris and I, we’re going to do everything in our power to ease the burden of health care on you and your family,” he said. “I will protect your health care like I protect my kids with my own family.”

Yet Biden’s health plans, including the creation of a public insurance option to compete with private insurance and more generous subsidies for middle class consumers, depend on the Affordable Care Act being in place. And though the majority of justices on Tuesday appeared unlikely to side with the Trump administration and red state arguments that the entire law should be struck down, the uncertainty will hang over health care markets possibly through spring. And if Republicans keep control of the Senate and the law is struck down, Democrats’ hopes for passing a replacement would be quashed.

Both Biden and Vice President-elect Kamala Harris described the Obamacare lawsuit as an attempt to “overturn the will of the people” following multiple unsuccessful attempts by Republican lawmakers to repeal the law in Congress, and cited their election night win as evidence that the public does not want the ACA’s protections eliminated.

“Health care was very much on the ballot in 2020,” Harris said. “Each and every vote for Joe Biden was a statement that health care should be a right and not a privilege. Each and every vote for Joe Biden was a call to protect and expand the Affordable Care Act, not to tear it away in the midst of a global pandemic.”