WASHINGTON, D.C. — When President Obama visited Capitol Hill on January 4, reportedly to huddle with congressional Democrats about how to preserve the Affordable Care Act, Vice President-elect Mike Pence was meeting in the House basement with Congressional Republicans to strategize on how to repeal the ACA, popularly known as “Obamacare.”

In an interview that same morning with Crux, Sister Carol Keehan, the president and chief executive officer of the Catholic Health Association, said she found it “heartbreaking” that legislation to provide health insurance coverage and access to health care for millions of Americans ultimately has become a political football.

“The impact on the people who now have insurance and could have it taken away needs to be the primary focus,” she said, noting that since the ACA was signed into law in 2010, an estimated 22 million Americans gained health insurance coverage for the first time.

The headline of a New York Times article on Jan. 1 – “Job No. 1 When New Congress Meets? Dismantling Obama’s Health Law” – summarized the priority of the Republican-led Congress that was to be sworn in that week, and reflected the promise of President-elect Trump to “repeal and replace Obamacare.”

“You hear the House, Senate and President-elect are going to repeal (the ACA), but we don’t have a clear and definitive bill to replace it,” Keehan said.

The Catholic Health Association president said the prospect of steps being taken to repeal the Affordable Care Act, without specific replacement bills introduced that could be analyzed for their effectiveness and cost, raises the specter of those millions who gained health insurance under the program in turn losing that safety net.

That possibility, she said, “is incredibly painful.”

“To see that go away, and know what that means in their lives is heartbreaking,” she said.

While most Catholic discussion over the ACA has focused on its controversial contraception mandates, Keehan suggested that the bigger picture of expanding health care coverage for vulnerable people shouldn’t get lost amid that debate.

Keehan, who first worked as a nurse before eventually becoming a Catholic hospital administrator and now the head of the Catholic Health Association, said, “I have spent over 40 years in health care. A huge percentage of what I’ve done…is to address the situation, the suffering and stress, of people who don’t have access to health care.”

She said she has met and spoken with people helped by the Affordable Care Act, people who told her about the impact of their new health insurance coverage, including families who could now have medical care provided for their children, and individuals who could now go to the doctor, get their prescription filled, and have tests done at a hospital.

“These are people who work very hard. They wait on us in restaurants. They drive taxis. They clean our rooms in hotels. They work one or two jobs, but they can’t (otherwise) afford to go to the doctor,” Keehan said.

For her, it comes down to the people who gained health insurance and health care access under the Affordable Care Act and who could lose it if the ACA is repealed without replacement legislation.

“Think about these 22 million people, if they are pregnant, getting treatment for cancer, have diabetes, or if their child has cystic fibrosis, suddenly the security they had” with health care is gone. “Think how frightening that is,” she said.

Keehan said she holds out hope from what President-elect Trump said in a 60 Minutes interview five days after the election, in which he pledged that the millions who gained coverage under the ACA would not lose it before a replacement law would be in force.

In that interview, Trump said, “No, we’re going to do it simultaneously. It’ll be just fine. We’re not going to have, like, a two-day period and we’re not going to have a two-year period where there’s nothing. It will be repealed and replaced…And it will be great health care for much less money. So it’ll be better health care, much better, for less money. Not a bad combination.”

Trump also told 60 Minutes that he considered the ACA’s requirement that people with pre-existing conditions have health insurance coverage “to be one of its strongest assets,” and he also said he would work to keep the measure’s provision that adult children living with their parents still maintain coverage for an extended period.

The Affordable Care Act has been criticized for the rising cost of health insurance premiums for small businesses, consumers and states, including in a full page ad in the Washington Post paid for by the U.S. Chamber of Commerce on the first two days when the new Congress was in session.

That ad had the headline, “Welcome back Congress. Your constituents are about to be hit by another Obamacare tax increase.”

Keehan said that she was not saying the Affordable Care Act is “the perfect answer” to the nation’s health care ills.

“It needs to be fixed,” she said. “You have to sit down (and see) what things are not working, and get the best minds together on how to do this.”

Keehan recommended that finding the resolution requires getting the input of the people now getting coverage under the ACA and hearing what that has meant to them and their families, and also needs the participation of stakeholders like health care providers, insurers, employers and health care and economic experts.

“This should be everyone contributing (on finding) the best way to do it,” and it shouldn’t devolve into a partisan fight, she said.

Keehan said the context of Catholic teaching on health care, and what the health care situation was like prior to the ACA’s passage, needs to be understood.

“The Church’s teaching on health care is it’s a basic human right, not an optional service,” she said.

Before the Affordable Care Act was passed, “we had almost 50 million Americans without health insurance,” she said.

She noted a 2002 study by the Institute of Medicine that found nearly 18,000 Americans die every year because they don’t have health insurance. (A 2009 study by the Harvard Medial School and Cambridge Health Alliance found that 45,000 deaths annually could be linked to a lack of health insurance coverage.)

When people lack health insurance coverage, “they don’t get preventive care because they can’t afford it,” she said, adding that can mean people not getting treatments like mammograms, colonoscopies or annual physicals, and then not seeking medical help until it’s too late.

“What the ACA did was make a start at trying to address that immoral situation,” she said.

Keehan conceded that “the ACA is a very imperfect law and it needs to be adjusted. But it has given 22 million of those 50 million Americans health insurance for the first time.”

She noted that in Kentucky, the Affordable Care act helped reduce the number of citizens in that state lacking health insurance coverage, from 38 percent to 13 percent of residents, and the totals for West Virginia are similar, she added.

Along with the health risks that a repeal without a replacement law would pose to citizens who could lose their health insurance, Keehan noted that independent think tanks have researched the issue and warned that such steps could also destabilize the health insurance marketplace.

Under that scenario, Catholic and other hospitals would “see a substantial increase in charity care and bad debt,” she said, but again emphasized that the key impact could be felt on the people who could lose their health insurance.

On his campaign website, Trump had pledged to “repeal and replace Obamacare with Health Savings Accounts” and to “work with Congress to create a patient-centered health system that promotes choice, quality and affordability.”

Keehan said she remains hopeful that the president-elect will do what he said on 60 Minutes, when he promised there would be no gap in health care coverage, and the new coverage would be as good or better than that provided under the ACA.

That, said the Catholic Health Association president, would be “something to build on.”

By day’s end on Capitol Hill, Pence said at a press conference that the Trump Administration from “day one” would keep its campaign pledge to repeal and replace Obamacare, through executive actions and legislation, but it would be done in an “orderly transition to something better…that doesn’t work a hardship on American families who have gained insurance through this program.”

That point was echoed by House Speaker Paul Ryan, who said, “We’ve been saying all along, we don’t want to pull the rug out from under people while we’re replacing the law.”