WASHINGTON (CBSMiami) – In less than 24 hours, the United States Supreme Court will issue its biggest ruling since Bush v. Gore in 2000. The Supreme Court will issue its ruling on the Affordable Care Act just after 10 a.m. Thursday.

The ruling will have ripple effects throughout the state of Florida and the U.S. as the Affordable Care Act will impact Medicaid, health care spending, and even tax returns. Florida has been at the lead of the lawsuit trying to invalidate the Affordable Care Act.

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Before the ink on the law was even dried when President Barack Obama signed it, then Florida Attorney General Bill McCollum announced the state was going to challenge the law and several aspects of it in federal court. Dozens of other attorneys general across the country joined Florida’s suit.

The speculation over what the Supreme Court will do has been building ever since the case was launched. Supreme Court experts said the oral arguments before the court earlier this year did not go well for President Obama.

The most controversial part of the Affordable Care Act is the “minimum coverage” provision, or what some have termed the individual mandate. In that provision, Congress mandated all Americans must buy health insurance by 2014 or pay a tax penalty until the buy a policy.

The mandate is central to anything the Court will rule on Thursday and will be the linchpin of the decision that most of the media will focus on in the days and months after the decision.

According to SCOTUSblog.com, the Court will decide on the legality of the mandate; whether the Court has the authority to decide the fate of the mandate; and if the mandate is struck down do other parts of the law have to fall as well?

As to whether the court can decide the law; that goes back to the Anti-Injunction Act first put in place by Congress in 1867, according to SCOTUSblog.com. That law prevented people from suing the federal government over a tax until the tax has actually been enacted.

If the Court believes this is a binding precedent in the Affordable Health Care Act, it means that no one can challenge the law in court until 2014 and a decision might not come until 2015.

The Court could choose to uphold the entire law, which would make everything in the Affordable Care Act, including the mandate and the expansion of Medicaid, the law of the land. That would end the dispute.

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This would be a victory for President Obama and Democrats across the country. It would put Republican-led states like Florida into a scramble mode to enact insurance exchanges that many states have resisted until a court decision is made.

The Court could also decide to strike down the individual mandate by severing it from the rest of the law. If that happened, Congress and the states would be forced to deal with how to get prices under control without forcing people to enter the insurance market.

States could pass their own mandates, similar to the one Republican Presidential Candidate Mitt Romney passed in Massachusetts. Congress could also past a different version of the mandate that could pass Constitutional muster, but that would be difficult in the current gridlock in Washington.

During oral arguments, the justices voiced opposition for having to go through the entire law and remove distinct provisions relating to the mandate. Thus, the court may not be willing to invalidate the mandate without striking down the entire law.

If the mandate is severed and ruled unconstitutional, insurance companies would still be required to accept all persons, regardless of pre-existing conditions and limit what the companies charge the oldest and sickest customers, according to the Huffington Post.

The Court could strike down the entire law. That would revert the entire health care system back to roughly 2009, but prices would continue to escalate across the board and further plunge the country into debt with Medicare costs skyrocketing with the overall price of medical care exploding.

Then there’s the issue of the Medicaid expansion called for in the law. The expansion would require states to expand Medicaid to 133 percent of the federal poverty line. That would incur great costs to states, but the federal government would continue to give money to help offset the costs to a degree.

Many programs in the federal government are handled this way and if it’s struck down under Congress’ spending clause; it could open the flood gates to other suits challenging the way the federal government funds thousands of programs.

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Regardless of the decision, the fate of tens of millions of Americans’ health rests in the hands of the Supreme Court. The debate over health care is far from over and will receive a kick start starting Thursday at 10 a.m.