On the eve of President-elect Donald Trump’s inauguration, Elm City health officials and residents have expressed concern about the repeal of the Affordable Care Act.

“Some people will lose everything,” said Kelvin Dixon, a city resident.

Another four residents interviewed expressed similar sentiments — worry that they or other residents could lose insurance. Meanwhile, four physicians, city administrators and health policy experts interviewed pointed out the many positive effects that the ACA has had on resident health.

Michelle Duprey, Director of New Haven’s Department of Services for Persons with Disabilities, said she is particularly anxious insurance companies will return to using a lifetime cap, a prescribed limit on funding for treatment which ACA eliminated. She mentions that she has known 10-year-old children with bone disorders who hit the lifetime cap for physical therapy that had to last a longer time.

Duprey noted that adults who have ongoing health care needs for chronic conditions might also be unable to continue treatment if lifetime caps were used.

Yale professor of radiology and economics Howard Forman is also reluctant to see ACA go, saying that the legislation has led to fewer uninsured patients. A trained physician, Forman has noticed that patients now have more choice and opportunities to follow-up on their appointments than they did before ACA was passed.

But Yale physician Merceditas Villanueva, who directs the HIV/AIDS program at the Yale School of Medicine, noted that many patients she sees do not completely realize their benefits from Obamacare and the effect that its repeal would have on them.

“Many patients hear what’s happening in the news, and they don’t know what to think,” she said. “People just don’t know what to expect.”

As an administrative official in close contact with health program funding, Villanueva has seen some clear positives of the ACA. With the legislation, Villanueva has observed that physicians strive for a higher quality of care and make more concerted efforts to examine data on patient satisfaction.

Such progress might be blunted after ACA repeal, especially if a replacement plan is not put in place immediately afterwards, according to Forman. Trump has said he has a replacement plan that will provide “insurance for everybody,” but has yet to reveal what that plan is, as the Washington Post reported on January 15.

Still, time is of the essence. “People can’t wait,” Dixon said.

Dixon expects that the repeal will lead to over-flooding of emergency rooms as people scramble to find free or affordable health services.

This week the Congressional Budget Office, a nonpartisan federal agency that provides Congress with economic information, released a report predicting 18 million Americans would lose their insurance within a year after Obamacare is repealed. By 2026, the CBO projects that number to be 32 million.

Though many Americans would lose their federally funded insurance, the CBO report also predicted that repeal of the ACA would also lead to 11 million more Americans insured under employer insurance packages by 2026. Such programs are an important source of “not completely affordable, but somewhat more affordable” insurance, said Mark Schlesinger, a professor at the Yale School of Public Health.

Trump has vowed to make his health care plan more cost-effective than the ACA while also cutting taxes, as he said during his presidential campaign. Schlesinger said he believes this would only be possible by eliminating state health care exchanges, and thus their administrative costs, as well as providing generous tax cuts for families who cannot afford insurance. But to guarantee that all families are able to afford health care, subsidies would be needed.

“You’re cutting taxes for people who don’t pay a lot of taxes anyway,” Schlesinger said. “The only way you can make insurance affordable is to subsidize it.”

Schlesinger referenced “negative” tax subsidies, which was proposed by the Nixon Administration, whereby the government actually gave money back to people. Only then can health care be affordable for even the poorest people, Schlesinger said.

Still both Schlesinger and Villanueva expressed the sentiment that a single-payer system, in which the government provides comprehensive blanket health insurance for all, is ideal. Any other system would be unaffordable in comparison, said Schlesinger.