Efforts to repeal the Affordable Care Act could take away health insurance from millions of Californians, while also eliminating 209,000 jobs and costing the state economy $20.3 billion in GDP, says a new report from the Center for Labor Research and Education at the University of California, Berkeley.

Center researchers conclude that the state’s Central Valley — which is already struggling with high unemployment — will be among California’s hardest hit regions as residents there also rely heavily on Medi-Cal.

Not only would California experience substantial loss of jobs and GDP, but the researchers estimate that the state and local governments would lose a total of $1.5 billion in tax revenue as a result of declines in income tax, sales tax, and other tax revenue.

On the other hand, repealing the ACA could include tax cuts to high-income individuals and insurers; and the elimination of penalties for uninsured individuals and large employers not offering affordable health insurance to employees. The economic effects of these changes, worth a combined total of $7.6 billion to California’s residents and businesses, are included in the study. 

Read more about how dismantling the ACA could impact California.