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Some insurers may decide to bail out of markets altogether.

“I woke up, really, in horror,” said Alice Thompson, 62, an environmental consultant from the Milwaukee area who purchases insurance on Wisconsin’s federally run health insurance exchange.

Thompson, who spoke with reporters on a call organized by a health care advocacy group, said she expects to pay 30 per cent to 50 per cent more per year for her monthly premium, potentially more than her mortgage payment. Officials in Wisconsin, a state that went for a Republican presidential candidate for the first time in decades last fall, assumed the federal subsidy would end when they approved premium rate increases averaging 36 per cent for the coming year.

An estimated 4 million people were benefiting from the cost-sharing payments in the 30 states Trump carried, according to an analysis of 2017 enrolment data from the U.S. Centers for Medicare and Medicaid Services. Of the 10 states with the highest percentage of consumers benefiting from cost-sharing, all but one — Massachusetts — went for Trump.

Kentucky embraced former President Barack Obama’s Affordable Care Act under its last governor, a Democrat, and posted some of the largest gains in getting its residents insured. Its new governor, a Republican, favours the GOP stance to replace it with something else.

Roughly half of the estimated 71,000 Kentuckians buying health insurance on the federal exchange were benefiting from the cost-sharing subsidies Trump just ended. Despite the gains from Obama’s law, the state went for Trump last fall even as he vowed to repeal it.