Obamacare has created access to health care for roughly 22 million Americans, approximately half of whom were previously uninsured. Despite multiple efforts over several years to curtail and repeal this important legislation, Obamacare is still fulfilling its mission. It remains far from perfect and requires refinement but should not be replaced. Cost efficiencies and quality of care remain a challenge, and there are still more uninsured who should be covered, but this legislation is worthy of continued support.

The opponents of Obamacare have not been able to replace or repeal it because they have not been able to come to agreement on where to go from here, and a true bipartisan effort has been elusive. The chief concern today is that in the absence of consensus, Obamacare will increasingly come under siege and sabotage to the benefit of no one. Like a human body, which depends on a working digestion for nutrients, the liver to clear toxins, kidneys to filter the blood and the heart to pump it, the ACA consists of a series of interconnected provisions that make Obamacare work.

If insurance companies no longer receive subsidies for waiving copays and deductibles for low-income consumers, the markets will become unstable and premiums will continue to rise.

If insurance participation is not supported through tax deductions and tax penalties, the markets will be weakened further, and those who opt out will still end up costing society when they go to the emergency room. All of these people will need care eventually. Finally, Medicare must be given the ability to negotiate on drug pricing.

Uncertainty with respect to all of these issues rattles the markets, confuses consumers and increases perceived risk on the part of insurers, which augments the likelihood that more companies will opt out and weaken the existing health care system.

Hawaii has long been a health care leader. In 1974 the landmark Prepaid Healthcare Act was passed by the state Legislature, which enabled us to insure most of our citizens, by mandating that any person working more than 20 hours per week received employer-sponsored health insurance. Since that time Hawaii has consistently ranked as the state with one of the lowest uninsured rates, usually hovering around 9 percent. We in turn have been continuously ranked No. 1 nationally for almost all health outcomes. By several measures we are the nation’s healthiest state.

State Sen. Josh Green, a Big Island Democrat who is also an emergency room doctor, said: “We’re now witnessing from afar the health care debate in Washington, D.C., which proposes to repeal and likely replace the Affordable Care Act, also known as Obamacare. This proposal from the Republican-led Congress, supported by President Donald Trump, would radically roll back the health care safety net as Americans know it. It proposes almost $1 trillion dollars in cuts to the Medicaid health care safety net over the next decade. Hawaii alone would lose over $200 million a year in health care support for our people, $2 billion over 10 years.

“When Obamacare was passed into law in 2010, it enabled states like ours to provide health insurance coverage for many more of our people. In Hawaii we were able to expand our Medicaid program from 252,000 low-income citizens to approximately 362,000 covered individuals. This lowered our uninsured rate to below 4 percent.

“From a practical standpoint this meant that more than 100,000 additional Hawaii residents had the coverage they needed for their families, especially children and adults with chronic illness. It meant that people didn’t have to choose between paying rent and paying for health care visits. It meant people could stop worrying about going bankrupt if they had a health care crisis in their family. It meant a young mother didn’t hesitate to bring her child to see me in the ER when her keiki had an asthma attack or an ear infection or perhaps something much more serious like leukemia.

“If the current health care proposal passes, it will not only force as many as 100,000 Hawaii residents to again become uninsured, but it will also put our health care safety net, especially the rural hospitals and health centers, into grave jeopardy. Independent physicians will be less able to work in areas that aren’t densely populated or have too many uninsured people. It will be a disaster,” Green concluded.

Repealing Obamacare is not the answer. Placing it under siege is even worse. Efforts to forge a bipartisan solution to improve and refine this legislation, which is already insuring so many more Americans, is the only reasonable course of action.

Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.