Even if Donald Trump preserves parts of Obamacare, as he has hinted he might, people with chronic conditions will still probably find care out of reach

In spring 2006 four years before outgoing president Barack Obama would enact the Affordable Care Act my partner, Dick, ran out of his arrhythmia heart medication and ended up in the ER with severe chest pain.

He was uninsured. At the time, insurance companies could still deny you coverage based on a pre-existing condition in his case, a chronic heart condition caused by the muscular dystrophy he was diagnosed with at age three. Since he was 20 years old in 2006, he was no longer covered under his mothers policy, and his job didnt provide health benefits. So he had no way to refill his medication when he ran out. That led to severe chest pain, which brought him to an ER in Brooklyn, New York.

Dick told the admitting nurses and the attending doctor about his condition. Diagnostic tests showed he had abnormally high liver enzymes, a symptom of muscular dystrophy. But its also a side-effect of cocaine use. Despite our objections, the doctor convinced himself that Dick was abusing cocaine. He had to get a second opinion in order to believe what has been Dicks lifelong truth.

That was the first time Dick would encounter a doctor ignorant about his disease, but not his last, navigating the murky waters of free clinics and bottom-ranked hospitals as an uninsured patient. But for the last two years, the ACA has made it possible for Dick to have broader access to health insurance and, thus, better doctors. His condition is being managed successfully for the first time since he was a minor.

But Republican lawmakers have been gunning for the ACA since before it even passed. Mere hours after Donald Trump was declared president-elect, the US Senate majority leader, Mitch McConnell, announced that the GOP-controlled Senate would prioritize repealing the historic, yet troubled, act. And under a Trump presidency, that could actually happen.

Though Trump said late last week that he would consider keeping the ACAs pre-existing condition provision as part of his own healthcare reform plan, his ever-evolving proposal would nonetheless have dire consequences for everyone, not just people frightened that their health history would again put affordable healthcare out of reach.

As Vox pointed out last week, a blanket ban on discriminating against pre-existing conditions without the public exchange and subsidy aspect of Obamacare would suffocate the free market premiums would soar. And that would trigger a rising uninsured rate across the board. If Trumps plan is to keep parts of the ACA while axing others, there will still be a snowball effect that will penalize the people that rely on it.

Unraveling the progress made under the ACA would threaten the health and economic wellbeing of a large group of Americans. It would mean people with disabilities and chronic conditions in particular wouldnt be able to properly treat their condition, if at all. It would mean their health would deteriorate further, which would make it harder to maintain a job and, therefore, their ability to maintain a home. Since employer-provided insurance is never a guarantee, an ACA repeal would mean the difference between security and uncertainty.

Dick is fortunate to have insurance now. But if he were to lose it, or if it became unaffordable, we would lose the safety of knowing hes an appointment away from life-saving medication. And that would put him back in that emergency room, with that untrained doctor who just wont believe hes not a cokehead.

Read more: https://www.theguardian.com/commentisfree/2016/nov/14/dismantling-aca-catastrophic-donald-trump