David Hutchinson got health insurance for the first time in his life about a year ago. Now he’s worried he might lose it.

After someone helped him sign up through the New York Health Exchange, he enrolled in Blue Choice Option, a Medicaid plan managed by BlueCross BlueShield. Hutchinson, 52, is one of many Americans who got insured with the passing of the Affordable Care Act.

He says he paid close attention to this year’s presidential campaign, especially Donald Trump’s promises to dismantle the Affordable Care Act. Hutchinson knew his health insurance could be at stake.

“I worried about it for me and many more people who cannot afford it,” Hutchinson says.

Trump called the ACA a catastrophe and vowed to change it “very, very quickly.” While it’s decidedly too soon to know exactly what changes would happen when, 2.8 million New Yorkers who’ve signed up for health insurance through the exchange might be impacted.

Trump ran on a few different ideas for amending the current system such as tax free health savings accounts, the opportunity to buy insurance across state lines to encourage competition and changing the way Medicaid funding works. Last week the President-elect told the Wall Street Journal he may consider keeping parts of Obamacare.

New Yorkers may not be affected by some of these anticipated federal changes because of policies in place at the state level. In some ways, the Affordable Care Act is really like 50 different Affordable Care Acts. Policies, procedures, and prices vary state by state.

“New York state had already implemented a lot of the tenets of the Affordable Care Act even before the Affordable Care Act took effect,” explains Leslie Moran, vice president of the New York Health Plan Association, which represents almost all of the insurance companies in the state.

In the 1990s, New York passed legislation, that was unique at the time, known as guaranteed issue. (These provisions were later blamed for insurance becoming unaffordable.) It protected patients from discrimination based on pre-existing conditions, age or sex, Moran says. In 2002, another law passed requiring insurance companies to cover contraceptive drugs or devices. In 2009, a separate law passed that allowed young adults to stay on their parents insurance until the age of 29.

But what is at stake for New York is federal funding for health coverage, including the estimated $804 million that currently subsidize 90 percent of the low cost Essential plan, which is insurance for people who don’t qualify for Medicaid or can’t quite afford a private insurance plan, Moran explains. The federal government also pays for 50 percent of Medicaid costs as well as tax credits for insurance premiums. Most New Yorkers who have signed up through the exchange are enrolled in a Medicaid plan or the Essential plan.

While national changes could be significant, the impact will come down to how individual states react.

“That’s the big question. If [New York] wanted to continue offering these programs, the state itself would have to find some way—you know, find those dollars. That’s the big question hanging over all of our heads,” Moran says.

In Trump’s campaign platform, he proposed Medicaid would operate as a state block grant program. Each state would get a capped amount of money for Medicaid coverage.

“The block grant is a finite amount of money. And a state might use that up and say to other people, ‘Sorry, you're not eligible, we've used up our block grant,’” says Sarah Liebschutz, a SUNY professor emerita of political science, who has researched ACA implementation in New York for the Rockefeller Institute of Government.

There are still a lot of questions about how a block grant formula would work, such as whether it would incorporate people who have become eligible for Medicaid because of the expansion, Liebschutz says.

These uncertainties shouldn’t stop you from signing up for insurance during this open enrollment period, Liebschutz adds. No major changes are anticipated before the end of 2017.

“The wheels of government turn slowly and there will be lots of lots of input before action is taken,” Liebschutz says.

Side Effects Public Media is a health reporting collaborative based at WFYI in Indianapolis. Karen Shakerdge can be reached at 585-258-0246 or kshakerdge@wxxi.org. Follow her on Twitter: @karenshakerdge.