Obamacare took a blow from the federal judiciary on Wednesday — one that might lead to leaving millions of Americans without health care insurance.

The 2-to-1 decision by a three-judge panel of the U.S. Court of Appeals for the 5th Circuit, based in New Orleans declared the “individual mandate” in the Affordable Care Act (ACA), requiring all Americans to have health insurance, is unconstitutional.

This may seem unimportant because Congress has already removed any penalty for violation of the individual mandate from the law.

But Wednesday’s ruling “leaves the rest of the sprawling statute in limbo heading into a presidential and congressional election year,” reports the Washington Post.

Following its decision, the appeals court chose to send back to a lower court a vital question: whether the entire ACA can stand without the individual mandate.

“The decision carries significant political implications,” the Post says: “It catapults to the forefront of the 2020 presidential and congressional campaigns questions about insurance coverage and consumer protections for people with preexisting medical conditions — issues that Democrats wielded in last year’s midterm elections to win a House majority.”

However, Wednesday’s ruling on the individual mandate may not be final; it could be appealed to the Supreme Court.