A new government report shows that the number of Americans directly involved in the Affordable Care Act – and what happens to it after the November elections – is bigger than you might think.

Almost 50 million people have private health insurance through the Affordable Healthcare Act marketplaces in the ten years since their inception, according to U.S. Treasury Department calculations released Tuesday morning. That’s about one in seven Americans.

This is also about two and a half times the number of people who Marketplaces today. The reason the 10-year total is so much higher is because people are getting insurance from different sources over a longer period of time as their circumstances change.

For example, you could leave a job with health insurance benefits to become self-employed and then purchase individual health insurance through one of the marketplaces, such as HealthCare.govwhere they would be entitled to the financial support provided for by the Health Act.

The number is important because the future of the 2010 law is likely to depend on the election outcome.

Republican candidate Donald Trump is a longtime critic of the program, which became known as Obamacare because it was former President Barack Obama’s most significant legislative achievement.

Trump attacked the program for years and then, when he moved into the Oval Office in 2017, tried to desperate to Repeal it. He failed, but last year He recommended He said on social media that he was still interested in repealing it, saying the law “sucks” and that Republicans should “never give up” trying to “abolish” it.

When these posts drew criticism from defenders of the law, he said he simply wanted to replace it with “MUCH BETTER HEALTH CARE.” It was a version of the same promise He made this demand repeatedly during his 2016 campaign before taking office, pushing for legislation to repeal laws that would have deprived millions of people of their insurance coverage.

Given the Democratic Party’s staunch support of the law, Trump would almost certainly need a Republican Congress in his second term to pass repeal. And even then, given the ACA’s popularity and the political backlash Republicans faced the last time they tried to repeal it, convincing lawmakers to do so could be difficult.

But a determined Trump administration and even a somewhat lenient Congress could find ways to roll back the law, even if it would not result in a complete repeal.

They could try to cut or limit funding for the Medicaid expansion introduced by the law, which is likely even more people than the Marketplace coverage. Two prominent conservative political publications – the Heritage Foundation’s 2025 Project and the House Republican Study Committee’s 2024 budget proposal – supported versions of this idea.

Trump and his Republican allies could also try to renew the a major but temporary upturn to financially support the Affordable Care Act, which President Joe Biden and the Democrats introduced.

Because of this boom, 15 million Americans who now buy insurance through the marketplaces are saving an average of $800 a year, according to Calculations from the Ministry of Health and Human Services.

This boom is one of the reasons why the number of new enrollments in the market has increased so sharply in recent years and why the number of uninsured people in the country – that is, the proportion of the population without health insurance – has reached an all-time low.

The additional support expires after 2025. Democrats, including Vice President Kamala Harris, the Democratic presidential candidate, have said they want to extend it into the future.

Neither Trump nor the Republicans have made much of a statement on the issue, but they are likely to oppose an extension, not least because of the cost, which the Congressional Budget Office recently estimated at $335 billion over 10 years. This money would have to come from somewhere.

But without renewal, private insurance through the marketplaces would become more expensive and potential buyers would be forced to pay more for their policies or give up insurance coverage altogether. And as Tuesday’s new report shows, over time this would affect a significant portion of the population.