A report by George Washington University and the Commonwealth Fund estimatesthousands of jobs would be lost in Wisconsin if two key elements of the Affordable Care Act, also known as Obamacare, are repealed.

An estimated 46,000 jobs could be lost in Wisconsin if the Republican-controlled Congress and President-elect Donald Trump roll back Medicaid and eliminate subsidies helping people pay for health insurance, according to the study.Leighton Ku, lead author of the report andprofessor at George Washington University, said less health spending has a ripple effect.

“When hospitals, doctors offices, pharmacies, when they lose money, they hire fewer staff, they lay people offand then in addition they buy less things from other vendors who provide, you know, the mortgage for their facility, they purchase medical equipment from IT facilities and all sorts of other services. So it trickles out,” said Ku,who is also the director of the Center for Health Policy Research.

Republicans have long contended the Affordable Care Act is “job-killing.” But Ku contends the ACA has resulted in more, not fewer, jobs.

“If you look at the fact that the unemployment rate has gone down to very low levels over the past few years, the economy is doing pretty well – maybe not as well as you might hope – then it’s sort of clear that those claims have not been true,”Ku said.

Ku’s study examined how Republicans might pull money from the ACAby eliminating tax credits for individuals and extra funding for states that expand Medicaid. Wisconsin did not expand Medicaid using federal funds but Ku saidthe state could still lose jobs because of other states that expanded Medicaid.

“Wisconsin gets an indirect effect, and that’s because people in states that have expanded Medicaid, they buy goods that come from Wisconsin,” he said.”And so if there are [job] losses that occur in New York, California or Michigan that also hurts Wisconsin too.”

Trump has said repealing the ACA is a priority,however,Republicans may delay that repeal while they come up with a replacement. Some Republicans have said certain popular provisions of the law, such as staying on parent’s insurance until age 26 orno denial for pre-existing conditions, might stay.