Medicaid expansion population as of Nov. 7, 2016

The Medicaid expansion population by parish as of Nov. 7, 2016. Image via the Louisiana Department of Health.

A come-from-behind win like that of Donald Trump in the biggest sweepstakes in the land inevitably causes uncertainty about future national policy in a lot of areas, but there is one where Gov. John Bel Edwards is likely to be most concerned: expansion of Medicaid insurance coverage.

More than 330,000 new clients have signed up under the expansion pushed by Edwards. It is perhaps the governor’s signature achievement so far.

But it is also part of the U.S. Affordable Care Act, or “Obamacare,” a key target of Trump and other GOP candidates successful in this election cycle.

There are obvious problems with the “repeal and replace” slogan used by the GOP, the biggest being what would replace the exchanges selling private insurance. But perhaps the most vulnerable are the working poor, people in low-wage jobs that are covered by the ACA-funded expansion.

The Wall Street Journal reported Friday that Trump said in an interview he will consider keeping some pieces of President Barack Obama's signature health care law after meeting with Obama earlier this week.

“I told him I will look at his suggestions, and out of respect, I will do that,” Trump told The Wall Street Journal. “Either ‘Obamacare’ will be amended or repealed and replaced.”

That is common sense, because of the disruptions in the lives of so many families, in Louisiana and in the majority of states across the nation that have expanded Medicaid.

“I think there are a lot of unknowns here, and I think that Louisiana and all the expansion states really need to watch what the Republican president and Republican Congress plan to do with it,” Diane Rowland, a health policy expert at the Kaiser Family Foundation, told The Advocate.

We don’t know what the ultimate answers to the questions arising from “repeal and replace” are, but we are sure that Louisiana is better off with its workers covered by health insurance. The pre-ACA model of people working until they drop, then clogging emergency rooms because they had no other physician they could afford, is not sustainable.

Is sickness better than health? Of course not. Are costs, particularly from the ER, shifted on to other patients’ insurance plans? Of course they are.

We reject the argument of GOP critics of Medicaid, who dwell on its flaws but — at best — talk vaguely of “high-risk pools” for the sickest patients, as if those worked previous to the ACA’s adoption.

“Repeal” is easy to promise, but “replace” is the hard part.