Seven years ago, when University of Richmond professor Rick Mayes traveled with volunteer clinicians from Virginia Commonwealth University and the University of Virginia to a free health clinic in Grundy, in Southwest Virginia, there was not enough time in a weekend to see all the patients.

“Those first four years we went before Obamacare went into effect — those were horrible weekends,” he said during a talk about “TrumpCare” at the University of Richmond on Tuesday. “There were far more patients coming out than there were times for the physicians and clinicians to see them.

“The patients would come up and it would be one of those ‘Sophie’s Choice’ or Faustian bargain (moments), where they had three forms — pink, red and blue; one was dental, one was vision, and one was general medicine. And we had to tell them, ‘You can’t pick all three.’ Even though almost all of them needed all three, we had to say to them, ‘You have to pick, you have to choose one over the other.’ And it was horrible.”

Then three years ago the entire weekend changed. Instead of turning away patients on Sunday evening because the clinicians had to get back to their regular jobs, the volunteers would see all the patients by Saturday afternoon, Mayes said.

That was because of the Affordable Care Act, he explained. The clinicians also saw far fewer West Virginia and Kentucky residents because those states expanded Medicaid.

“Then the clinicians could spend all the time they needed, and see the patients multiple times,” Mayes said. “And the students could really see — even though Obamacare has its flaws and its misgivings and its failures, overall it’s had a tremendously positive effect on some parts of the country.”

Mayes spoke Tuesday on what the future of health care might look like, which became a talk about what challenges are before the Republicans who control Congress and, soon, the White House, aiming to replace Obamacare with something as good or better.

Last week, the Centers for Medicare and Medicaid Services relayed the latest marketplace enrollment numbers during a media call.

As of Dec. 24, in Virginia, 399,106 people had signed up for coverage in the Affordable Care Act’s marketplace, more than at the same time last year. Of those Virginians, more than 216,000 were women and more than 46,000 were children.

“Over the past few months, or even the past few years, we’ve heard repeated claims that the health insurance marketplace is in a ‘death spiral,’” said Aviva Aron-Dine, senior counselor to the secretary at the U.S. Department of Health and Human Services, during the call.

“As a simple factual matter, we can now declare these claims false,” she continued. “A death spiral is defined as a market that is rapidly shrinking. … In contrast, today’s data shows that this market is not just stable, it’s currently on track to grow.”

President-elect Donald Trump swore during his campaign to repeal the Affordable Care Act, saying it caused premiums to spike and would ultimately destroy the U.S. health care system.

But if he repeals without rolling out a feasible replacement immediately, 10 to 20 million people will lose health coverage, which is why Republicans are scrambling to put together a replacement.

Mayes said the options currently on the table all include three characteristics: turning Medicaid into a block-grant system in which the federal government will give states a certain amount to run Medicaid how they see fit; allowing insurers to sell across state lines; and replacing subsidies with tax credits based on age, not income.

“The older you are, the bigger the subsidy you get,” Mayes said.