It may be hard to believe, but the Affordable Care Act (ACA) turned 5 years old this year.

Since enacted, the ACA has cut the rate of uninsured Americans by one-third. Now, 16.4 million more people have insurance nationwide, including 37,000 additional people in Hawaii.

Of those 16 million-plus, people of color and young adults have made the biggest gains when it comes to access to health care. These numbers are significant, and the impact on women is substantial.

From a provider perspective, we have seen a positive impact as a result of the ACA. The biggest impact we have seen at Planned Parenthood is the increase of patients covered by Medicaid because Hawaii decided to expand Medicaid. Today, more than 319,000 people in Hawaii are enrolled in Medicaid. This means adults with low-incomes have the access they need to health care.

By far the most consequential impact of the ACA is its focus on preventive care. At Planned Parenthood, this means our patients can access all forms of birth control and annual examinations with no cost-sharing obligations. This is a huge benefit to them.

It is important for people to have insurance, and the ACA, for the first time, allows everyone to have access to affordable insurance and health care. It provides for preventive care, allows youths to stay on their parents’ insurance until age 26, and requires insurers to cover you even if you have a pre-existing illness. None of this existed before the ACA.

In disappointing news, it was announced that our state-run exchange, the Hawaii Health Connector, will be shut down in September due to lack of funding. This means that about 37,000 people in Hawaii enrolled in the state exchange will be re-enrolled in the federal exchange for 2016, pending discussions between the state and federal government.

What is important to note about this change is that an upcoming U.S. Supreme Court decision, King v. Burwell, could send the ACA into even further upheaval. King v. Burwell challenges a core component of the ACA that endangers the financial assistance — premium subsidies or tax credits — that the law provides for low- and middle-income Americans who live in states without their own state-run health care exchange, which includes Hawaii.

The court’s decision is expected to come in June and will profoundly affect ACA’s future and whether women and their families can access affordable coverage. If the court throws out the financial assistance people enrolled in the federal exchange, affordable health care may be out of reach for the roughly 37,000 people in Hawaii and 1.4 million men and women across the country.

If that isn’t enough, earlier this year we learned that the Hawaii Health Connector did not comply with the ACA, and since the Connector will be shut down, the federal government now has the right to take away $1 billion from Hawaii in Medicaid funding.

The combination of the failed state exchange, the impending King v. Burwell decision and the potential loss of Medicaid funding does not put Hawaii in a good place.

This means we need to fight. We have made great progress in public health outcomes, thanks to expanded access to health care, but there is still work to be done. We are watching and fighting to ensure that we keep moving forward — not backward.

As the leading women’s health care provider and an advocate for Hawaii, we see firsthand the many benefits of the ACA and the financial help for women. We know that our health care system only really works if it works for everybody, which is why we fought so hard for the ACA in the first place.

Everyone, no matter their zip code or their income, should have access to basic health care.

Chris Charbonneau is chief executive officer of Planned Parenthood of the Great Northwest and the Hawaiian Islands.