With Republicans set to unveil their Affordable Care Act (ACA) repeal and replacement legislation this week, supporters of the healthcare law are warning of the “true cost” of scrapping the ACA, or Obamacare: loss of coverage for tens of millions of people, across many demographics and in each of the United States’ congressional districts.

This comes as the GOP continues to duck a public accounting of the human and financial costs of its proposal—and as analysts raise the alarm over its potential tax toll on middle-class workers.

A memo (pdf) prepared this month by Democratic staff on the House committees on Energy and Commerce and Oversight and Government Reform offers some context for the secrecy, showing that “repeal of the ACA would endanger coverage for newly insured Americans, millions of whom live in Republican congressional districts.”

Indeed, the analysis—based on federal health insurance data—found:

  1. All congressional districts and the District of Columbia have seen reductions in their uninsured rates since the ACA was implemented, with an average reduction of 5.4 percentage points;
  2. On average, 396,200 individuals with employer-sponsored insurance in each congressional district are at risk of losing important consumer protections if the ACA is repealed, and could be subject to a new tax on employer-sponsored insurance that would amount to the largest middle-class tax hike in the last 50 years; and
  3. On average, 360,200 individuals in each congressional district stand to lose access to free preventive care if the ACA is repealed.

What’s more, the analysis shows how constituents in Republican congressional districts have benefited from the ACA, in some cases with greater-than-average drops in uninsured rates.

Still, the analysis reads, “Despite the fact that significant numbers of their own constituents are currently enjoying the law’s many benefits, House Republicans continue to pursue their extreme, ideological agenda of repealing the ACA at any cost.”

The Indivisible movement, whose members spent a good portion of last month’s Resistance Recess organizing to save the ACA, urged its supporters to “save this document,” with its district-by-district breakdown, as ammunition for the fight ahead.

Advocates for specific demographic groups are also voicing concern about how the GOP’s plan to repeal the law would impact their communities.

For instance, Ann M. Starrs, president of the women’s health research group Guttmacher Institute, wrote in an op-ed Monday: “Full or partial repeal of the Affordable Care Act in particular would leave millions of women entirely without health insurance, while tens of millions more would see their insurance’s contraceptive coverage severely degraded.”

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