By Dianne Feinstein

Originally published by the Southern California News Group

Kate from West Hollywood enrolled in health insurance for the first time in 2014 when she was 39 years old. Five months later she was diagnosed with breast cancer. She wrote to me that she is “terrified” by the prospect of repeal of the Affordable Care Act.

Robert from Altadena needs a knee replacement. If he loses the insurance he obtained under the health care law, his pre-existing condition would make it impossible to find a new plan. He is weighing whether to schedule surgery as soon as possible or risk losing his insurance and being confined to a wheelchair.

Catherine from Glendale wrote that her brother has stage three liver cancer. Before the Affordable Care Act, he was insured sporadically due to high costs. Now, he is being treated at UCLA and Cedars-Sinai, two top hospitals.

As these stories from Californians make clear: repealing the health care law is not just a matter of politics. It is a matter of life and death for millions of Americans.

While state leaders are working to blunt the potential effects of the more extreme policies supported by President-elect Trump and congressional Republicans, the devastating effects that would result from the repeal of the Affordable Care Act would be unavoidable.

Right out of the gate, nearly 5 million Californians would lose their health insurance.

More than 3.7 million low-income adults — 1.1 million of whom live in Los Angeles County — would lose their Medi-Cal coverage. The federal government pays 90 percent of the cost of covering these individuals and it would be a huge challenge for the state to afford this on its own.

These individuals earn less than $16,000 per year. It would be nearly impossible for them to afford insurance on their own.

An additional 1.2 million Californians would lose the tax breaks they receive to purchase insurance through Covered California — the online marketplace for those don’t receive insurance through their employer but earn too much money to sign up for Medi-Cal.

These tax breaks allow nearly half of those eligible to purchase insurance through Covered California to pay less than $100 per month in premiums for the standard silver plan.

Repeal would also affect the state’s bottom line. California currently receives $20.5 billion per year in funding under the Affordable Care Act. This funding represents more than 10 percent of our state’s annual budget.

Six years ago California was $40 billion in the hole. While the state has recovered, this loss of federal funding would make it that much more difficult to balance California’s books and meet the state’s needs.

A new report from UC Berkley projects that repeal would cost the state more than 200,000 jobs by driving down demand for health care services and increasing the cost of uncompensated care.

The millions of Californians who would lose their coverage would likely delay seeking medical care. They would skip check-ups and screenings, and fewer doctors, nurses and other health care professionals would be needed to provide care.

Hospitals could be forced to shift funds from doctors’ and nurses’ salaries to cover the cost of caring for individuals without insurance.

While repeal would have the most immediate and devastating effects on the nearly 5 million Californians who have gained coverage under the law, rescinding the Affordable Care Act’s strong consumer protections would affect the vast majority of Californians.

Insurance companies would no longer be prohibited from denying coverage based on pre-existing conditions.

It’s estimated that one in four Californians under age 65 — 5.8 million people — have a pre-existing condition that would make them uninsurable in the individual market.

Insurance companies would also no longer be required to cover a wide range of essential health care services, including annual check-ups, prescriptions, hospitalizations, mental health and substance abuse counseling and maternity care.

Many of the services, including mammograms and colonoscopies, are covered with no additional out-of-pocket costs.

Forty-five percent of Californians — approximately 18 million people — receive health insurance through their employer. Their coverage could be worse.

These are just two of many examples of how repeal would affect all of us.

While I strongly oppose repeal of the Affordable Care Act, parts of the law are not working as well as they could be and need to be fixed.

Although California has seen smaller rate increases than other states, premiums in the individual market increased an average of 13 percent in the state this year.

These increases are not sustainable, and are often too high for individuals who don’t receive tax credits, particularly those aged 50-64.

While the growth of health care costs has slowed significantly, many middle-class families can’t absorb even small increases in their premiums and out-of-pocket costs. We need to do more in this area and I am eager to work across the aisle to address it.

Congressional Republicans face a real choice in the coming weeks — do they pull the rug out from millions of Americans or make a sincere effort work with Democrats to improve the Affordable Care Act? The latter is the only responsible answer.

Dianne Feinstein is California’s senior U.S. senator. She is a Democrat.