With the inauguration of President-Elect Trump on Friday, Republicans in control of both houses of Congress, and an open Supreme Court seat, it’s very likely that the Affordable Care Act (ACA) will soon be repealed.

No one knows quite how this will shake out, or exactly what the ACA will be replaced with.  If the ACA is repealed, there will likely be winners and losers.  However, unless the ACA is replaced with something similar, it’s very likely that some of the biggest losers of the ACA’s repeal will be people with disabilities.

That’s because people with disabilities were some of the biggest winners under the ACA.  The ACA (popularly called ObamaCare) includes strong protections for people with disabilities who have or want private health insurance.  Insurers are required to insure people with pre-existing conditions, which includes many people with long-term disabilities and other medical conditions.  Insurers must cover habilitative therapies, mental health treatment and substance abuse treatment.  Insurers cannot put a lifetime limit on how much they will pay for someone’s treatment, which for some people who need expensive medical care long-term, is quite literally a life-saver.

However, the dirty truth is that all of these extra benefits are expensive, and to pay for them, insurers have had to charge healthy people more.  Insurers have raised premiums, and introduced “high-deductible” plans where customers must pay a large amount out of their own pocket before the insurer will pay anything.

But with the repeal of the ACA looming, the benefits above, which disproportionately help people with disabilities, may soon go away.  So perhaps would the ACA’s Medicaid expansion, which expands Medicaid eligibility beyond aged, blind and disabled people with very limited assets and income, to any adult with income less than 138% of the federal poverty level.

The ACA gave people with disabilities the option to buy private health insurance, and another avenue to obtain public insurance through Medicaid.  But both of those options may soon disappear.  That means that for people with disabilities, Medicaid may (again) soon be the only way to obtain healthcare coverage.  And that in turn means that establishing and preserving eligibility for Medicaid is now more important than ever.  People with disabilities should consider how special needs trusts and ABLE accounts can preserve eligibility, parents with children with disabilities should explore special needs estate planning, and lawyers working with people with disabilities should consider how settlements / recoveries will affect Medicaid eligibility.