Legislation to repeal and replace the Affordable Care Act may complicate the increasing shortage of healthcare workers, according to a report released Tuesday.

The ACA created health insurance coverage for 500,000 of the nation’s nearly 5 million direct care workers, the brief published by the Paraprofessional Healthcare Institute shows. Prior to the ACA, one in four direct care workers went without health coverage; the ACA contributed to a 26% reduction in the uninsured rate among healthcare workers.

Medicaid coverage among nursing home workers increased from 16% to 19% between 2010 and 2014, according to the brief. The uninsured rate among nursing home workers dropped from 28% to 20% after the ACA was passed.

“Policies that undermine the progress made by the Affordable Care Act, or that reform Medicaid’s financing structure, will make it increasingly difficult to attract sufficient numbers of workers to meet our nation’s caregiving needs,” said Robert Espinoza, vice president of policy for PHI, in a statement accompanying the brief.

The increase in healthcare coverage under the ACA also benefitted providers and residents, added PHI President Jodi M. Sturgeon, since access to healthcare means workers “don’t have to leave their jobs because of untreated illnesses or injuries, and they’re more capable of meeting the daily needs of those they support.”

Click here to view the full PHI brief.