My son spent most of the first year of his life in the hospital. During that time, he racked up more than $1 million in medical bills. Thanks to the Affordable Care Act — the landmark health reform bill signed into law by then-President Obama in 2010, just a year before my son was born —  our insurance company paid those bills. My son got the specialty medical care he needed, and my family wasn’t driven into bankruptcy.

Today, my son uses a ventilator at night, and the health insurance company pays to rent the machine. He’s more than his medical conditions — he’s a great kid who loves 3D printing and plays percussion in the school band. At age 13, my son is one of the oldest medically complex children to have been born into a health insurance system that didn’t put lifetime limits on medical care.

These protections have shielded my family and countless others from astronomical medical bills. Yet they are not guaranteed. The Affordable Care Act as it stands is on the ballot this presidential election. If former President Trump wins, he has said he would replace or change it.

Everyone loves a story about a miracle baby — a tiny baby who is born with a rare syndrome who lives thanks to heroic interventions from a medical team. My son is a miracle baby. He couldn’t breathe when he was born because he doesn’t have a functional airway. Doctors gave him an artificial airway (a tracheostomy) so that he could breathe, but he was too fragile to leave the hospital until he was 9 months old.

A lesser-known fact about miracle babies is that each one is also a million-dollar baby. A million dollars is a lot of money in the real world, but in the astronomically priced world of medical bills, a child can easily rack up that much from treatment for a particularly bad illness or accident.

Prior to the passage of the Affordable Care Act, health insurance companies imposed lifetime and annual limits on how much medical care they would cover. This impacted most Americans with private health insurance. Lifetime limits meant that insurance companies got to decide exactly how much a human life was worth. We’ve all gotten used to the little indignities of having to fight with health insurance companies to get them to pay for specific medical claims, but lifetime limits are worse. It’s fundamentally immoral for the system that is responsible for taking care of us to put a dollar value on human life — but prior to the Affordable Care Act that’s how the system worked. It was sadly a regular occurrence that when someone went through cancer treatment or other intensive medical procedures, families would be driven into bankruptcy or even lose their homes because of the medical bills, if they were able to get care at all.

Most people didn’t learn that their health insurance had a lifetime limit until they or their loved one got very sick. The truth of lifetime limits is so horrifying that people don’t want to believe it. They think that surely there must have been some exception, some government program that would just take over where the private market failed. There was a solution to the problem of lifetime limits: That solution is the Affordable Care Act.

Prior to this legislation, there were also no good solutions for people with pre-existing conditions. Health insurance companies discriminated against people just because they had previously been sick. Everyone gets sick, the entire point of health insurance is for the insurance company to pay for medical care when you get sick. Children like my son prove the fundamental ridiculousness of using pre-existing conditions to deny care. My son was born with a pre-existing condition. Should he be locked out of getting health insurance for the rest of his life because he was born disabled? Of course not.

The Affordable Care Act didn’t just ban lifetime limits, it also set rules requiring insurance companies to cover 10 essential health benefits. These benefits are common-sense things: ambulatory care, emergency care, hospitalization, pregnancy, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness care, chronic disease management, and pediatric care. But if the ACA is repealed, insurance companies will be free to issue policies that don’t cover critically important care.

If the Affordable Care Act is repealed or weakened at a federal level, California lawmakers can’t protect California residents from the consequences. Most Californians get health insurance from their employers, and only the federal government can regulate private health insurance plans that are self-funded. About 44 percent of Californians who get health insurance from their employers have this kind of insurance. That means California can’t protect our children from the return of health insurance that won’t pay for health care.

It’s important to understand what’s at stake for children with special health care needs if the Affordable Care Act is repealed. Former President Trump tried very hard to repeal it in his first term as president. He only failed because of a massive pressure campaign from disability and health care advocates and a single vote in the Senate. If the Affordable Care Act is repealed, my son and millions of other Americans will lose their health insurance.

We know how bad health insurance was before the passage of the Affordable Care Act. We can’t go back.

Jennifer McLelland is the California Health Report’s disability rights columnist. She also serves as the policy director for home- and community-based services at Little Lobbyists, a family-led group that advocates for and with children with complex medical needs and disabilities.