Image of nurses' hands at computer keyboard

If the Supreme Court invalidates the Affordable Care Act, long-term care facilities could be among the biggest casualties, a report published in advance of the decision states.

Medicaid, which pays for as much as 70% of the care received in skilled nursing facilities, is set to expand health coverage to 17 million new beneficiaries in 2014. But health policy experts warn that if that ACA provision is struck, states would be free to restrict eligibility requirements for the first time since 2009, Kaiser Health News reports. Multiple states have filed lawsuits challenging the law’s Medicaid expansion, arguing that it’s “unduly coercive.”

“Depending on how sweeping and broadly written the decision is, it could be the entire Medicaid program has been unconstitutional since 1965, but we didn’t know it,” George Washington University’s Sara Rosenbaum told Kaiser.

The Supreme Court is expected to issue its opinion on the ACA’s validity before the end of the month. The high court agreed to look at the parts of the law separately, meaning that it could, for example, strike down the individual mandate but say that the Medicaid expansion was constitutional.