According to the Centers for Disease Control (CDC), 33,880 Americans are killed by gun violence (not limited to homicides) on average per year.

If you compare that figure to the 50 to 60 annual gun-related deaths in the U.K., the difference (even when you account for per capita rates) is staggering. The rate of gun-related death in Canada was also seven times lower in 2012 than it was in the U.S. the same year.

Needless to say, gun violence often rises to the fore when discussing politics. But according to Vox‘s Julia Belluz, there’s something else on the American horizon that could kill more people per year than gun violence. The culprit? Repealing the Affordable Care Act (ACA).

Under the current administration, the likelihood that the ACA will be destroyed is high. More alarming than the repeal itself, however, is the fact that there is very little indication that anything will rise up to replace it.

While White House spokespeople and Donald Trump himself have ensured Americans that there will be a replacement that gives states power to control Medicaid, they have presented no concrete plan to the public about how and when that replacement would be implemented.

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So what does that mean? As of now, 20 million Americans are covered by the ACA and Medicaid expansion. For that reason, people are understandably alarmed by pending health care coverage decisions.

As Belluz points out in her piece, ACA-specific mortality studies are few and far between due to the relative youth of the legislation. “We do have something else though: many different studies on the impact of health insurance on mortality before Obamacare was in the picture,” she writes.

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