The potential repeal of the Affordable Care Act and the uncertainty over what might replace it have state lawmakers warning of a major budget hole in New York – and wondering how to remedy it.

At City & State’s State of New York Finance event on Tuesday, a panel of lawmakers and industry officials had more questions than solutions for how the state will prepare for and respond to a full repeal of the health care law, widely known as Obamacare.

“There’s these major shifts at the moment and New York has to start thinking about what we’re going to do to make sure we get as many New Yorkers covered with health care as we possibly can,” state Sen. Kemp Hannon, the Republican chairman of the state Senate Health Committee, said during the panel. “What I’ve been doing is looking at all the notes I have on how our ACA was constructed and what adds up to the elements that are in it. Then I realized as a state, we really have to go back further to what we did in 1996, when we moved to (the New York Health Care Reform Act of 1996).”

Hannon added that if New York were to preemptively develop a plan in preparation for a full repeal, the federal government could conclude that the state doesn’t need any financial assistance to adopt a new health care system.

One major concern the panelists raised is the loss of subsidies to New York if the ACA is repealed. Assemblyman Richard Gottfried, the chairman of the Assembly Health Committee, said if the federal government reduces its federal matching for Medicaid expansion and undoes the New York State of Health’s Essential Plan, it would result in close to a $4 billion loss in federal funding in the state budget.

“Even in New York that’s a lot of money,” Gottfried said. “When Washington takes billions out of our health care budget, we’ll have a choice: We can either allow our health care system to be severely damaged in that way or we try to fill those holes and that means trying to come up with several billions in money to put into health care. It’s hard to do that within the current budget.”

A repeal of the ACA could also impact many of the state’s other wellness programs. During the panel, the opioid epidemic was discussed and could see a loss of funding and disrupt the state’s efforts to combat the problem.

“We also can’t lose sight that the state has been making real strides and real efforts toward integration of care and recognizing care needs to be patient-centered,” said Anne Dyjak, managing director of capital investment for the Primary Care Development Corporations, adding it would also impact other substance abuse issues and mental health care. “ACA repeal can cause incredible disruption to all those efforts.”

Of course, state lawmakers are at the mercy of Washington, D.C., and can only wait to see what happens with the ACA and what any replacement will entail.