The Affordable Care Act proved a boon for Kentucky residents, with thousands not only obtaining health insurance through the Kentucky Connect exchange, but four times as many gaining coverage through Medicaid expansion.

But premiums soared last year, deductibles and co-pays increased and the number of available coverage choices fell, leading to growing dissatisfaction among those who have benefited most from President Barack Obama’s signature legislative achievement.

The drop in the number of uninsured in the state dropped dramatically, making Kentucky a model for the rest of the country. The first few months of the ACA’s operation saw more than 300,000 people qualified for Medicaid coverage, which raised eligibility to 138 percent of the federal poverty level — income of $16,000 a year for an individual and $33,000 for a family of four.

The state’s uninsured rate fell to just 7 percent with 440,000 insured in 2015 from nearly 19 percent in 2013, the biggest drop of any state.

Nationally, about 16.4 million people have gained coverage through the ACA, and the uninsured rate has dropped 5 percent nationally since 2013. More than 6.4 million Americans signed up for coverage in the latest enrollment period.

Some 24 million Americans remain uninsured, about 12.7 percent of the population. Analysts said the plan President-elect Donald Trump released during the 2016 campaign would increase the number of uninsured by 21 million. Other Republican proposals also would strip coverage from millions of Americans.

Kentucky voted overwhelmingly for Trump, who has promised repeal of the ACA, and Congress has taken the initial steps to make it so.

Republican Gov. Matt Bevin has said the ACA is unaffordable, estimating the state will have to pony up $1.2 billion from through 2021 to cover Medicaid costs, making it the biggest piece of the state budget after education. In October he took down the state exchange set up by former Democratic Gov. Steve Beshear.

“People say we cannot afford to go forward with the Affordable Care Act. How can we afford not to?” asked state Sen. Morgan McGarvey, noting screenings for cholesterol and breast cancer as well as dental checkups have more than doubled as a result of increased coverage.

A study by the Commonwealth Fund indicated Kentucky could lose nearly 45,000 jobs as a result of ACA repeal because of reduced federal spending. More than a third would be healthcare jobs.

Sen. Rand Paul, R-Ky., presented his version of a replacement for the ACA on CNN’s “State of the Union” Sunday, touting tax credits to help pay for coverage and increased use of Health Savings Accounts. He would scrap the mandates included in the ACA, including minimum coverage requirements, and favors sale of cheap, bare-bones policies to entice younger, healthier Americans to sign up.

Kathy Oller, an ACA enrollment worker in Kentucky, told Vox she thinks Trump will fix the problems of soaring premiums and dwindling choices because he’s a businessman, although she admits the ACA has done more good than harm.

About 40 people demonstrated in Courthouse Plaza in Lexington Sunday, protesting plans to repeal the ACA.

“We’re not just dealing with dollars and cents,” Tyler Murphy, the organizer of the rally, told the Lexington Herald-Leader. “We’re not just dealing with policies and laws. We’re dealing with people’s lives and healthcare in particular is a matter of life and death, literally.”

In an op-ed piece published earlier this month in the Cincinnati Enquirer, Sen. Mitch McConnell, R-Ky., argued the ACA has failed to control costs and forced people to switch doctors.

“President Obama used to hold Kentucky’s Obamacare exchange up as some kind of success story. But Kentuckians knew better, and we don’t hear him saying that anymore,” McConnell wrote. “Obamacare has become a mess in Kentucky, just like it has across the nation. In our state, premiums are rising by as much as 47 percent this year alone.”

A December survey by the Pew Research Center found Americans are virtually evenly split on the ACA and whether it should be repealed.