In Chicago, John H. Stroger Jr. Hospital of Cook County is among the nation's busiest hospitals, handling most of the city's gunshot victims. The vast majority of its patients used to be uninsured, and the county-run hospital struggled to take care of their medical and mental health needs.
Those patients now have Medicaid coverage because of the Affordable Care Act, and the Cook County hospital system gained $200 million in new revenue to cover their services, breaking even for the first time.
"We have no interest in slipping back in what we've been able to do," said Dr. John Jay Shannon, chief executive of the Cook County Health and Hospitals System. "We're not able to do the kind of work that we do today with good will alone. Our staff are not a volunteer staff. We can't get IV fluids and medical equipment on credit and a wink and a nod."
Two hospital trade groups — the American Hospital Association and the Federation of American Hospitals — have warned of "an unprecedented public health crisis" if the law gets hastily scuttled.
They say if Congress repeals the law entirely and 20 million people are kicked off their insurance, hospitals will lose $166 billion in Medicaid payments alone in the next decade.
And hospitals face much steeper losses if certain Medicare cuts that were part of the law aren't restored.
In Chicago, limo driver Jerold Exson is one patient who could lose coverage and have his hospital bills — once again — go unpaid. These days, the hospital helps enroll low-income adults such as Exson into Medicaid. In 2014, he was shot nearly a dozen times in a case of mistaken identity.
His medical care is now covered, and the hospital can provide follow-up surgeries, physical therapy and mental health treatment that were often off-limits to the uninsured.
Clinical psychologist Natalia Ruiz helps Exson manage the after-effects of gun violence. "I used to be real antsy," said Exson who suffers from post-traumatic stress disorder. He recalled a recent moment when he was driving and a "rock hit the window, and it kind of sent me into a tailspin."
The health law also shifted the business model for U.S. hospitals. It offered them financial incentives to move away from expensive ER visits to primary care and managing chronic conditions.
Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.