If the Affordable Care Act (ACA) is even partially dismantled, 18 million people could become uninsured within a year, according to a new report from the Congressional Budget Office (CBO). That number could nearly double to 32 million by 2026, the CBO estimated, if the Medicaid expansion is rolled back and subsidies cut to those who paid for insurance through the marketplaces set up under the ACA.

For some, the hardest part is the realization that older Americans, who will likely be hardest hit by changes to health care and discretionary spending, were among the Republican president-elect’s biggest supporters. “I have worked in gerontology since the ’80s,” said Toni Miles, MD, who heads the gerontology department at the University of Georgia. “I feel betrayed because older people voted for a guy I couldn’t stomach.”