Carolyn Goodrich, a patient at Denver Health's Frederico F. Peña Clinic, speaks with her physician, Dr. Anne Frank.

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The Affordable Care Act changed the equation for hundreds of thousands of Coloradans. Folks like Carolyn Goodrich, who now gets insurance through her job as a pharmacy tech. A few years ago, Goodrich, who is diabetic, was uninsured. She discovered she qualified for Medicaid, the insurance program for low-income Americans.

“It was a great help to me because it was something that I could afford,” she said. “When I was on the Medicaid I had nothing but good care.”

Goodrich was one of roughly 300,000 people who gained insurance when Medicaid expanded in Colorado under Obamacare. Before Medicaid, she’d have to choose whether to “pay my bills just to survive” or to pay for her medication.

The Denver Health Federico F. Peña Family Health Center opened in April 2016.

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People like Goodrich have a lot at stake as Republicans look to repeal and replace Obamacare. The same could be said for the Federico F. Peña Family Health Center, the clinic Goodrich visits regularly. It’s part of Denver Health, which is a safety net hospital -- a public institution that provides services to all, whether they can pay or not.

The 45,000 square-foot clinic, which offers one-stop preventive and comprehensive primary care, is located in a predominantly low-income and Hispanic Denver neighborhood off Louisiana Avenue and S. Federal Boulevard. It has services for urgent care, women’s health, nutrition, mental health, pediatric, dental, lab services, a pharmacy, x-ray and insurance enrollment.

Dr. Mike Russum, who helps lead the clinic, said that when the clinic, with its many specialties, opened in April it became a better option than going to Denver Health’s main facility downtown.

“It’s really a good location in terms of for patients being able to access, but then patients don’t have to go to the hospital anymore,” Russum said.

A big part of the story here is people gaining insurance through Medicaid. A few years ago, about 40 percent of Denver Health’s patients were uninsured. Obamacare, and the Medicaid expansion, cut that figure in half. That decreases the number of unpaid bills —so-called uncompensated care — the hospital has to cover.

Dr. Mike Russum, who practices family medicine, is the team leader at the Peña Clinic.

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“Definitely this clinic has benefited from Obamacare,” Russum said. “And this population has benefited from Obamacare by the expansion of Medicaid.”

That’s what helped make the economics work in putting a brand new $26 million clinic in a high poverty neighborhood. Dr. Simon Hambidge, Denver Health’s CEO of Community Health Services, said the hospital was able to “invest in a new clinic like this” because “the ACA made it possible for us to feel stable enough in our population that was not uninsured.”

Hambidge predicts the hospital will weather the storm if Obamacare is repealed and there are serious cuts to safety net programs, like Medicaid and Medicare, as some Republicans have suggested. But he concedes it’ll probably be harder to open new clinics in many neighborhoods.

“We’ll survive,” Hambidge said. “We may not be able to be as expansive because we would be back to less secure times.”

Chris Tholen, chief financial officer of the Colorado Hospital Association, said the Affordable Care Act has benefited both patients and hospitals.

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The Colorado Hospital Association is watching the situation carefully. Chris Tholen, its chief financial officer, said Obamacare reforms let patients seek care even for pre-existing conditions that had denied them coverage. It also encouraged them to go to the doctor earlier. In Colorado, that drove down emergency room visits by Medicaid patients 8 percent in the last few years. As a result, Tholen said, those patients got better, cheaper care.

“Whatever alternatives come forward, let's make sure we don't lose the benefits of the last four to six years that the ACA has provided,” Tholen said.

Hospitals are bringing their concerns to Washington as Republicans consider repealing and replacing the ACA. A pair of national hospital groups issued a letter to President-elect Trump and Congress warning of huge losses, layoffs and hospital closings if Obamacare is repealed without a satisfactory replacement.

“The overall message is the ACA has been beneficial for hospitals and other providers to care for patients and the overall population,” Tholen said.

Colorado’s implementation of the Affordable Care Act alongside Medicaid expansion “did improve the financial outlook for many Colorado hospitals,” said Care Welch, director of communications for the Colorado Hospital Association. She notes as Colorado’s uninsured rate was cut in half from roughly 15 percent, uncompensated care for hospitals also dropped. “Many Colorado hospitals benefited from that change,” she said.

Denver Health media relations manager Kelli Christensen said the hospital's board approved its 2017 plan and it does not call for any layoffs or reductions in services. But she said, “if the ACA is repealed, it could have an impact on our ability to expand our service offerings,” like specialty care at community health clinics, or adding new clinics like the Federico F. Peña Family Health Center.

Carolyn Goodrich, a patient at the Peña Clinic, wonders about the impact cuts to government programs could have on those with chronic health conditions. Even though she has insurance through her employer now, her parents are covered by Medicare. One is a diabetic, the other suffers from congestive heart failure. Like she has in the past, she sees folks facing a choice between mortgage payments or medications.

“I really don’t think there’s good things coming out of our government if they change it,” Goodrich said.

Another patient at the clinic, 64-year-old Denver resident Julie McGuire, echoed those concerns. “I know there’s going to be changes, I don’t know what they’re going to be,” she said.

McGuire is on Medicare and has Medicaid as a backup. She’s dealt with hearing loss and fibromyalgia. She’s personally grateful for the federal health programs. “A lot of times the poor didn’t become poor by choice, and so I personally know that it (potential cuts) affects a lot of people.”

But changes could be coming soon, as Republicans start to wrestle with how and when to repeal and replace the Affordable Care Act.