President Trump criticized Senate Republicans on July 24 for not passing a bill to repeal Obamacare, but said they were "very close" to doing so. (The Washington Post)

America could lose more than a million jobs if the Senate votes to repeal the Affordable Care Act on Tuesday.

That’s according to a report from George Washington University’s Milken Institute School of Public Health and the Commonwealth Fund.

“This legislation could single-handedly put a big dent in health care job growth,” said Leighton Ku, the lead author of the report and the director of the Center for Health Policy Research at George Washington University.

Repealing the law, also known as Obamacare, would dramatically scale back federal funding for health care, especially Medicaid. That translates into job losses as hospitals, retirement homes and other health facilities get fewer dollars.

“We're talking about one out of every 20 health care jobs disappearing by 2026. That's a lot,” Ku said.

Much of the debate over the “repeal and replace” of Obamacare has centered on how many Americans would lose insurance. The bill that Senate Republicans proposed would lead to 22 million fewer Americans with health insurance in the next decade, according to the nonpartisan Congressional Budget Office. The House Republican bill would leave 23 million fewer people covered, and a straight repeal of Obamacare would bring the most losses of all: 32 million off insurance, according to the CBO.

Job losses, however, get much less attention, despite the fact that health care has been a booming field for job growth. Even during the Great Recession, health care jobs continued to grow. A third of all jobs created in the United States in the past decade have been in health care.

According to the Labor Department, 15.7 million Americans have jobs in health care today — roughly 1 in 9 workers. And a lot of the job growth Trump has heralded so far in his tenure has also come from health care.

Trump says the Senate is “very close” to having the votes to pass, but it's clear the job impact is one of the concerns weighing on some Republican senators' minds. These senators are worried about what their home states would lose if they repeal Obamacare and enact the alternatives under consideration. Federal health dollars would drop, more people would lose insurance and many good-paying jobs would go away.

Since Obamacare went into full effect in 2014, 1.2 million people have gained employment in health care. Most of the jobs have come in hospitals and outpatient care where people are treated for non-emergencies. Many hospitals, such as Harris Medical Center in Newport, Ark., have seen their “bad debts” drop substantially since more patients have been able to pay since Obamacare was enacted. At Harris, bad debt has been cut in half. That has allowed hospitals to expand services — and jobs.

Sen. Susan Collins of Maine is one of the GOP senators who has come out strongly against the Senate's Better Care Reconciliation Act (BCRA). BCRA “would also jeopardize the very existence of our rural hospitals and our nursing homes, which not only provide essential care to people in rural America, but also are major employers in the small communities in which they are located," Collins said on ABC's “This Week.”

The CBO didn't calculate job losses, but the health experts at George Washington University did, using a similar economic model to the CBO's. “Our analyses shows that almost every state ends up being a loser on jobs,” Ku said.

The report finds that every state would lose health care jobs almost immediately as federal health care funding is cut, especially for Medicaid. The 31 states that expanded Medicaid funding, including West Virginia and Ohio, would be especially hard hit.

In total, nearly a million jobs in health care would be lost by 2026 under BCRA, as well as another half a million jobs in other sectors from the cutbacks in spending by health organizations and employees who are laid off.

The job losses under the House bill are similar, although slightly less (924,000 in total). Ku and his team didn't look at what would happen if the Senate just does a straight repeal of Obamacare without replacing it with anything, but Ku told The Washington Post the job reductions would likely be similar to the 1.45 million under BCRA.

As with any study, these are estimates. Assumptions had to be made and no one knows what the future will hold, especially in a field like health care that is experiencing innovative technological advances. Still, there's widespread agreement among economists that health jobs would likely decline in coming years under the GOP plans. The disagreement is over whether other sectors would gain or lose jobs.

“Congress definitely should be considering the impact of the Obamacare repeal on job growth in health care,” said Gary Young, director of the Northeastern University Center for Health Policy and Healthcare Research. “The question is does the repeal have a positive impact on job growth in other sectors of the economy?”

Young hasn't run his own models, but he points out that President Barack Obama helped sell his health reform by telling the business community that his plan would reduce health costs overall and thus spur growth in other industries. Job growth did pick up in Obama's second term, although it's debatable how much of a role health care costs played in that. Health care costs still grew, albeit at a slower pace.

For senators weighing whether to vote yes on Tuesday, a key factor is what Collins said: Many of the job losses would hurt communities that can least afford them.

“The groups that will get hit the most are rural hospitals and inner city teaching hospitals,” said Stuart Altman, a professor of national health policy at Brandeis University.

Many of those rural areas voted heavily for Trump. The president has said he wants to be the “greatest jobs producer that God ever created,” but the bills he is supporting in the Senate would likely slash jobs.