In the days after the election of Donald Trump, 38-year-old Ursula Garza began to think about planning her funeral.
Garza, who lives in San Antonio, Texas, is an insulin-dependent diabetic. For years, she’d gone without health insurance, forced to beg for insulin — which could cost her as much as $600 — from friends who worked in doctors’ offices and and from donation centers, picking up supplies vial by vial. Last April, she’d finally gotten coverage under the Affordable Care Act — a literal lifesaver, she said, that allowed her to get an insulin pump. But the effect of years without insurance had taken its toll: she lives with chronic pain, nerve damage, and vision problems.
Like millions of Americans, Garza is now contemplating the possibility that she could lose her health insurance if Donald Trump follows through on his campaign promise to repeal the Affordable Care Act. If Obamacare goes, Garza, a single mother to an 11-year-old daughter, doesn’t know how she would survive.
“It’s very scary to me — the thought of him taking it away is just a nightmare,” she said. “There’s only so much a body can handle. If I find myself uninsured again, I don’t know what will happen. It sounds morbid, but I've been looking at funeral plans."
The question of what President-elect Trump will do with the Affordable Care Act is, like much of his presidential policy, up in the air. It has left many preparing for the worst: transgender people who say they are rushing to stock up on hormones or schedule reassignment surgeries, women who say they plan to get implanted birth control devices for fear the costs of monthly pills will become unaffordable again.
"We have no idea yet" what will happen to the 20 million people who are currently insured on the exchanges, said Gary Claxton, a vice president at the Kaiser Family Foundation, a health care nonprofit. Under a Trump presidency, "whatever comes next will be pretty different, and how you get there has the potential for disruption."
Late last week, after spending months on the campaign trail promising to get rid of the Affordable Care Act, he signaled that he was open to keeping some key parts of the law, like a ban on denying coverage because of pre-existing conditions. But despite some support on both sides of the aisle, retaining coverage for those with pre-existing conditions is far from simple, Claxton said.
"In the ACA, all policies are available to anyone who wants them" regardless of pre-existing conditions, he said. "But that's dependent on a lot of other things that allow it to work, like the individual requirement to have insurance and subsidies to bring healthy people into the market. Those things aren't particularly popular."
If the individual mandate is repealed, experts say, there will not be enough healthy people paying into the system — or paying penalties for lack of insurance — to cover the steep costs of insuring people who are already sick. Insurers would have to deny those sick people coverage, or, at the very least, force them into costlier insurance plans or those that don't pay for conditions they already had.
That deep uncertainty has weighed heavily on the minds of people like Garza, who have only recently adjusted to life with health insurance. "Right now I just don't know," Garza said. "Will there really be insurers that will offer plans for people like me, with pre-existing conditions, that I can afford?"
Joel Walker, 30, of Dayton, Ohio, began to fix his rotting teeth after he got health care coverage for the first time in ten years under a Medicaid expansion. He's waiting now to be fitted for dentures. "It should be the first time in — wow — a decade that I'll be able to smile with a mouthful of teeth," Walker said.
Walker, who is also taking medication for a heart condition, said he has felt as though he was "inside a steel cage of depression" since the election, worrying what will happen if he loses access to his dentist, cardiologist, or the medicine he's dependent on if the ACA is repealed. He voted for Hillary Clinton, but for the first time in 28 years, his county, Montgomery, flipped Republican. "To put it bluntly, I felt a little betrayed," Walker said.
For some, however, the looming end of the Affordable Care Act offers a shred of hope. Laura Mansour, a retired nurse in Bradford, Pennsylvania, got insurance through a state exchange but found she could no longer cope with the price of her insurance, which had a $638 monthly premium, a $7,000 deductible and co-pays that had climbed to almost $100 for a doctor's visit. With no choice, she said, Mansour dropped her insurance this year, planning to go uninsured until her Medicare coverage kicks in.
Mansour, like "everyone" in the 8,600-person town where she lives, supported Donald Trump, partly out of a hope that he will bring jobs back to coal country and partly, she said, because she is counting on him to lower health insurance costs. "They need a whole new revamp," Mansour said. "Everybody should be able to get health care, but I don't think you should be penalized for not having it."
In Belleville, Illinois, Rebecca Gabriel says her entire family has been touched by the Affordable Care Act. It's allowed her to insure herself and her two children for just $35 a month, covering the costs of a monthly medication that has "changed" her son's life. Without insurance, they would pay $236 for the medication alone.
In the next town over, Gabriel's niece, who has severe brain damage from a car accident, is reliant on ACA coverage. "That's what we're really freaking out about," Gabriel said. "Because of Obamacare, they can't put a lifetime cap on her insurance, they can't boot her off because of a pre-existing condition. She was in a coma for more than a month — her hospital bills were well over $1 million. Obamacare has been a lifesaver for us."