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Keynote speaker Gov. John Bel Edwards speaks at CABL’s 2016 Annual Meeting and Luncheon at L’Auberge Conference Center Thursday Dec. 8, 2016.

With the prospect of repeal of the Affordable Care Act, also known as “Obamacare,” families and institutions are looking at the implications for Louisiana’s new expansion of Medicaid insurance for the working poor.

There is a real fear that many families now covered would lose Medicaid under a repeal bill. “Repealing the ACA without having a well-developed replacement in effect is dangerous to the people of Louisiana and the future of our state,” said Susan Todd, of 504HealthNet, which represents Louisiana health care providers who serve the poor.

We share that concern. Louisiana was late to the expansion party, having sharply limited access to Medicaid and refusing under former Gov. Bobby Jindal from taking advantage of the ACA. Last year, Jindal’s successor, John Bel Edwards, opened the door to expansion and hundreds of thousands of working families are now enrolled.

We hope that communities across the state — large and small — also take note of the risks on the legislative front.

If the ACA is repealed without a “replacement,” whatever that might look like, the institutions serving the working poor will continue to get patients, except that many of those working-age adults won’t be able to pay.

That is why hospitals and clinics across the state should also be alarmed at the prospect of precipitous legislative action on Capitol Hill. For every urban clinic worried about its customers, there is a rural hospital or doctor’s office where a large number of new insured patients have come in with a Medicaid card, courtesy of the ACA.

Medicaid is no panacea for every poor health outcome, but it is a darn sight better to have insurance rather than none at all. Edwards, speaking to the Council for a Better Louisiana in December, highlighted the people who are now being treated for cancer, diabetes or other diseases that might have gone undetected, with potentially fatal results.

The expansion of Medicaid also saved the state budget money, because it is funded by the U.S. government at a generous match rate. It’s still taxpayer money, but it brings dollars back to the state that we pay in federal taxes.

Finally, we hope the public discussions of Medicaid expansion also note that people with traditional insurance coverage benefit: When those previously uninsured go to a hospital, that facility’s costs to provide care to the indigent are significantly lessened.

Medicaid isn’t perfect, from either the patient’s standpoint or from the financial realities of providers. But in a state with a large percentage of its people working in low-wage jobs, either in the city or the country, we need to have a discussion across Louisiana about the potential problems if the new president and Congress act too hastily with regard to Medicaid.