With the transfer of presidential power only days away, there is much speculation about what this will mean for the Affordable Care Act. ACA, popularly referred to as “Obamacare,” was first passed in 2009 and sought to offer affordable heath insurance options to millions of uninsured Americans. In 2014, according to a Census Report put out by the US government, 33 million people were insured due, in part, to the ACA. The numbers were down from a 2013 report that estimated 41.8 million Americans were uninsured. While these numbers represent the increase of Americans who now have coverage, what the outcome of the repeal of the ACA looks like is unknown.

The ACA has subsidies attached to it, and through the elimination of the program, it would affect the most disenfranchised portions of the US population; the working poor receiving Medicaid. The repeal of the bill means that roughly twenty million people who got coverage through the ACA, a portion of which is on Medicaid, lose these funds. For Medicare recipients, the ACA resulted in paying less for insurance, as well as prescription drugs.

Another major concern is women’s access to birth control. In 2010, because of Obamacare, health insurance plans were required to give women access to birth control without a co-pay. Several states such as California, Maryland, Vermont, and Illinois acted separately to to pass a state law that enforces what the ACA currently upholds. Similar actions are pending in other states including New York, Colorado, Minnesota, and Massachusetts.

Without an alternative plan in play, millions would lose coverage and go without needed medication and face fees for seeking out doctors in an effort to get treatment. A study put out last week by The George Washington University concluded that the repealing of the ACA “would lead to a doubling of the number of uninsured, higher uncompensated care costs for providers, and higher taxes for low-income Americans.” The potential loss of insurance for millions could also result in 2.6 million jobs. The study notes, most of these jobs would be lost in the private sector as well as in the healthcare field.

The attempted Republican tactic of trying to the ‘repeal and replace process’ does not leave a plan in play now. With the threat of completely eliminating the program, there is much speculation about the outcome of premiums and deductibles. According to Healthinsurance.org, “The plan designs for 2017 are already locked in, and enrollment is underway. The legislation to repeal subsidies is expected to come in 2017. But it’s unlikely that it would take effect before 2019, because Congress and the IRS need time to implement a replacement plan.”

In terms of the current state of insurance regulations, if ACA were to be dismantled it could result in lower costs across the board. According to a 2016 Forbes article, “Eliminating Obamacare’s onerous marketplace regulations and benefit mandates alone will dramatically reduce insurance costs.” The article went onto say that tax deductible that usually goes to the insurance companies under the ACA, would now go to the tax payer directly. With the GOP’s possible plan this could result in “individuals with high-deductible health plans to put aside money tax-free to cover out-of-pocket medical expenses. Consumers can roll the funds in their HSAs over from year to year.” This could possibly mean lower costs all the way around but there are many details that still need to be finalized.

On January 12, 2017 the Senate voted 51 to 48 to begin the process to dismantle the ACA. The next phase will be to send it to Congress for a vote. A vote for the date is still pending and even if the Senate bill is upheld, it would likely take months if not years to see the plan fully implemented.