Tom Murphy
and Kelli Kennedy

Dawn Erin went nearly 20 years without health insurance before the Affordable Care Act, bouncing between free clinics for frequent and painful bladder infections.

Hepatitis C made her ineligible for coverage until President Barack Obama’s law barred insurers from denying people with a medical condition. She has since seen a specialist, and her insurance covered about $70,000 in prescription drugs.

“I don’t want to go back to the old way of doing things, worrying if I’m going to have the money to get my bladder infection treated,” said the 46-year-old self-employed massage therapist from Austin, Texas.

Erin was among more than 20 million people in the U.S. who gained coverage under the health overhaul, which has pushed uninsured rates to historic lows over the past few years. The law also aims to improve health by getting the poor and newly insured back into regular care and away from sporadic clinic visits or expensive options such as emergency rooms.

GOP efforts to replace the law are expected to increase the number of uninsured and may derail the steady push to bring people back into the health care system, which many doctors and health policy researchers see as essential to reducing some costs and improving quality of life.

It seems simple to connect patients with a primary care doctor for preventive care such as flu shots or regular monitoring of diabetes and other chronic conditions, to prevent future expensive health costs. But that often means overcoming problems that include making it to the doctor, a mistrust of the health care system or language barriers just to get patients into the waiting room.

Experts say they’re concerned about the number of uninsured possibly swelling again just as signs of progress are seen.

The GOP health plan that passed the House this month proposes cuts to the state-federal Medicaid program that covers the poor. That includes ending extra federal payments to 31 states that expanded Medicaid to cover more people. The measure would water down subsidies to help people buy coverage.

A recent projection from the nonpartisan Congressional Budget Office estimated the House bill would result in 23 million more people going without insurance in 2026.

Medicaid’s expansion boosted the bottom line — and number of insured patients — at Chicago’s Cook County Health & Hospitals System, one of the nation’s largest public health systems.

It has seen a drop in ER visits tied to chronic illnesses like high blood pressure, diabetes or asthma since the ACA expanded coverage while overall visit levels have stayed the same.

Primary care practices are seeing an uptick in returning patients. About 40 percent of the 190,000 Medicaid patients new to practices monitored by the technology firm athenahealth have returned for four or more visits in 18 months after making an initial trip in 2014 or the first half of 2015.

Repeat visits are critical so doctors can better monitor chronic conditions or improve patients’ overall health.