REGIONAL— For years, Congressional Republicans have voted and vowed to repeal the Affordable Care Act, otherwise known as Obamacare. Now, with the surprise election of Donald Trump last month, Americans might soon get to see exactly how such a repeal could impact their health services close to home.

About 25 million Americans currently receive their healthcare from a nationwide network of about 1,600 community health services. They provide medical and dental care through about 9,000 individual clinics, including facilities in both Cook and Tower.

This vast network of clinics provides care to everyone, without regard to their ability to pay. That’s made possible by significant federal funding that is earmarked for such clinics, much of which comes through the Affordable Care Act.

“About 70 percent of our funding comes through the Community Health Centers Trust Fund, established through the ACA,” said Mike Holmes, CEO of the Cook-based Scenic Rivers Health Service. He’s also the treasurer of the National Association of Community Health Centers, and he’s closely involved in the political discussions beginning to take shape around the future of healthcare should Congress and soon-to-be President Trump follow through on their promises to repeal the ACA.

At this point, Holmes said, most healthcare providers are operating mostly in the dark. “The prospect of new legislation creates a tremendous amount of uncertainty in the health care delivery system,” he said. “It may change, and may change dramatically. But right now, we’re working off of limited information from the president-elect.”

Washington, D.C., however, is already abuzz with talk of a repeal of the ACA, although whether Republicans will choose to replace it with something else, and what a new law might look like, is largely unknown. But Trump’s recent nomination of Tom Price, a staunchly conservative member of the Tea Party caucus in Congress, to serve as his Health and Human Services Secretary, is prompting speculation that the incoming administration may push for significant changes to the full suite of health care programs, from the ACA to Medicaid and Medicare.

Depending on the details of those changes, it could have major ramifications for healthcare access, particularly in areas like northern St. Louis County, which are served by community health centers, like Scenic Rivers. If the ACA is repealed, or funding for the health center trust fund is not renewed, that could lead to the closure of many health care centers, or require them to charge higher rates for services. That means that the details of any potential replacement for the ACA will determine how extensive the impact of repeal might be. Among the other potential changes is a proposal by House Republicans to turn Medicaid into a state block grant. Holmes notes that the Medicaid expansion included in the ACA was a major factor in cutting the number of uninsured Americans roughly in half since implementation of the law. If Republicans repeal the ACA, and don’t include the Medicaid expansion in a new version of healthcare reform, the number of uninsured could rise quickly again, notes Holmes.

“We could be looking at 50-60 million uninsured again,” he said.

Despite the prospect of major changes in the healthcare sector, Holmes remains hopeful that funding for community health centers will remain intact. “Community health centers have been around for over 50 years and we have had really strong bipartisan support during that time,” he said. “We take care of everyone, regardless of their income, or their political affiliations.”

For now, Holmes said, community health centers are focused on re-authorization of the ACA’s health center trust fund, which will disappear a little over a year from now without congressional action.

Beyond that, Holmes suspects other major changes could take time. “We don’t foresee any immediate changes,” he said, noting that much of Washington stays the same regardless of who sits in the White House, or heads Congress.

“Now everybody’s looking at [nominated HHS secretary] Tom Price to see what he’s said in the past. But we don’t know who the undersecretaries or agency heads are going to be. There’s 4,000 different appointees that will need to be hired and it doesn’t happen overnight.”

And Holmes points out that medical service providers have made significant changes to their own operations as part of adapting to the ACA and he suspects Congress and the new White House could face some pushback from the healthcare sector as congressional leaders and White House policymakers begin to develop more detailed plans. “Right now, there’s very little detail in any of the Republican proposals. And these things take time to play out.”