A dental hygienist cleans the gums of a patient at CCI Health and Wellness Services in Silver Spring in April. (Andrew Harrer/Bloomberg)

Maryland, particularly Montgomery County, has become a bright spot in the national health-care picture. From 2012 to 2015, subsidies to health insurance purchasers and the expansion of Maryland’s Medicaid program under the Affordable Care Act caused the percentage of uninsured Marylanders to fall from 10.1 percent to 6.7 percent. The national average is 9.4 percent.

In 2014, the state pushed to increase reliance on community-based health centers, rather than emergency rooms, generating healthier outcomes at a lower cost. In Montgomery County, the Care for Kids and Montgomery Cares programs reinforce this positive trend by providing the uninsured greater access to outpatient care. Tragically, Republican threats to the ACA, also known as Obamacare, are jeopardizing these gains.

Maryland has a unique method of pricing medical services and setting compensation for health-care providers. Under its All-Payer Model, Maryland’s Health Services Cost Review Commission publishes compensation schedules governing hospitals. In all other states, hospitals negotiate prices with insurance companies and other payers.

Until 2014, the commission specified the rates that hospitals could charge patients for various procedures. By the mid-2000s, however, administrators noted rising hospital costs. They concluded that low prices for various procedures were generating increased use.

In response, the state capped the annual amount that hospitals could bill for treating patients. The goal was to reduce avoidable admissions, readmissions and hospital-acquired infections. One result has been an increasing number of partnerships between hospitals and community-based organizations, with the latter taking on greater responsibilities. Outcomes are improving while costs are leveling out. Health-care experts are also optimistic that obesity and smoking rates will decline noticeably, leading to even greater improvement in the health of Maryland residents.

James McGee, executive director of the Transit Employees’ Health & Welfare Fund, described Maryland’s efforts as groundbreaking. “It’s exciting to see the kinds of transformations that can occur when incentives are aligned toward quality instead of quantity. But it is just a beginning.”

Federally qualified CCI Health & Wellness Services operates nonprofit health centers in Montgomery and Prince George’s counties. Dental care, family planning, routine checkups and inoculations are available in one location. Specialists are chosen from CCI’s established network.

CCI treats anyone in need. It accepts most private health insurance, Medicaid and Medicare. Uninsured patients are charged according to a sliding-fee scale based on income and household size. Because of efficiencies, economies of scale and low administrative costs, community-based health centers serve 16 percent of the U.S. population at only 2 percent of the total cost of care, said communications director José Luis Diaz.

When asked how CCI can afford to treat uninsured indigent patients, Diaz noted that payments from Medicaid, insurance companies and patient fees cover expenses. Additional funding comes from block grants. CCI also benefits from a provision in Obamacare that authorizes the forgiveness of medical school debts owed by doctors who practice in the public interest for the first four years after graduation.

In Montgomery County, two safety-net programs supplement private insurance, Medicaid, Medicare and other government programs. At a small gathering, County Council member George L. Leventhal (D-At Large) spoke with pride about Montgomery Cares and Care for Kids. Begun in 2005, Montgomery Cares serves approximately 40,000 of the estimated 80,000 Montgomery County adults who lack any other coverage and whose income is at or below 250 percent of the national poverty level.

Likewise, Care for Kids ensures that every Montgomery County child who needs treatment can see a doctor regardless of family income or citizenship at a community clinic. Leventhal noted that by reducing significantly the number of uninsured residents, the ACA made it easier for the county to cover those few left behind. He also pointed out that Montgomery County has the healthiest residents in Maryland, although its median family income is not as high as Howard County’s.

Maryland and Montgomery County have largely succeeded in making quality health care accessible and affordable for virtually all residents. Proposed legislation by the Republican Congress and President Trump would undo these advances. A recently passed House bill axes $880 billion in Medicaid payments to the states over the next 10 years, with nearly all of the cuts redounding to the benefit of the richest Americans in the form of lower taxes.

The president’s budget would slash even deeper, taking another $610 billion from Medicaid, leading to an astonishing 47 percent reduction in outlays. Many poor and working-class residents would lose insurance altogether or experience a great reduction in coverage. Because Maryland relies on Medicaid payments to cover otherwise uninsured residents, many will also lose access to health care.

Diaz raised another concern. The House bill would eliminate the debt-forgiveness program that attracts many young doctors to community centers. Without it, some public-spirited medical school graduates might steer clear of nonprofit clinics.

If the Republicans succeed in dismantling Obamacare, they will wreak havoc on the comprehensive medical delivery systems that state and local legislators, hospital administrators and direct-care providers have developed. The wealthy will enjoy a tax cut while poor, working and middle-class Marylanders endure higher health-care costs and bankruptcies and suffer from more illnesses, a higher obesity rate and a shorter life span.

The writer, a member of Maryland’s Healthcare Is a Human Right campaign, is an activist with Progressive Maryland and Our Revolution Montgomery County.