The Affordable Care Act has survived one repeal attempt in the Supreme Court, as well as more than 50 repeal attempts by the House of Representatives and the Senate. However, President Barack Obama's signature legislation faces yet another significant challenge to its existence.

In the current case before the Supreme Court (King v. Burwell), a ruling in favor of the plaintiffs this June would essentially cut off the healthcare law's tax credits/subsidies in roughly two-thirds of the states. That would mean that most of the people now buying insurance through the federal government online marketplace — HealthCare.gov — would be unable to afford it.

The result would create a domino effect in which more than 8 million people would end up uninsured, and insurance companies would raise premiums and pull out of markets due to the sudden loss of customers. There is nothing historically or politically that would predict how the American people would react to this benefit loss in such a short time frame.

And the "8 million" number is even more troublesome when you consider the discrepancy between how many individuals the Department of Health and Human Services (HHS) claims have enrolled (16.4 million) since 2010, versus what the Gallup-Healthways Well Being index shows, which is that there are 9.7 million fewer uninsured adults now compared with 2010.

Clearly, the way these numbers are gathered points to different methods resulting in different estimates, but the one thing it does point out is that they are different. There seems to be no dispute that the ACA has significantly reduced the number of uninsured Americans, but the question is, by how much?

The cost effect of the ACA on both insurance companies and the small business community has also not gone unnoticed.

In a recent article published in the International Journal of Health Services, the chief finding was that instead of the ACA reducing health insurance companies' spending on overhead, the insurers' financial filings show the law had no impact on the percentage of expenditures on such things as administration, marketing and profits.

What about the effect on the consumer? With tax day less than a month away, many Americans are still unaware of the penalty that will be assessed for those who have not signed up for coverage. Even though the enrollment deadline was extended through tax season, from Feb 15 to April 15, it appears that many Americans are just realizing for the first time that they are eligible for healthcare, that there is a penalty or even that there was a deadline.

The thought is that by linking the enrollment period to the tax filing date, it will give many Americans the chance to enroll and avoid a penalty. However, in a survey by tax preparation firm Jackson-Hewitt, it was clear that many Americans still don't know they can sign up for health insurance and thus avoid a tax penalty.

The coming months will be quite interesting for the ACA, which has already seen plenty of drama since its passage in 2010.