Partial repeal of the Affordable Care Act through a budget reconciliation bill could cause nearly 30 million Americans to lose health insurance and 9.3 million to lose government subsidies to help them purchase marketplace coverage, according to a new analysis.
The additional 29.8 million uninsured – 22.5 million from the elimination of the Medicaid expansion alone – would push the national total of the uninsured to 58.7 million in 2019, according to the analysis by researchers at the Urban Institute. The analysis is to be published Wednesday morning.
That’s more than the 50 million who lacked coverage in 2009 before the health law was passed, said John Holahan, a senior fellow at Urban Institute and co-author of the report.
More than four out five of the newly uninsured would come from working families; 56 percent would be non-Hispanic whites.
Coverage losses would be greatest in the 31 states and the District of Columbia which expanded eligibility for Medicaid under the ACA, the report found.
In those states, the number of uninsured would rise from 14 million to 32.5 million. Non-expansion states would see an increase from 14.9 million uninsured to 26.2 million.
California would lead all expansion states with nearly 4.9 million people losing coverage while nearly a million would become uninsured in Pennsylvania, 775,000 in Washington state and 486,000 in Kentucky.
Among non-expansion states, the uninsured would grow to more than 2.5 million in Texas, more than 2.2 million in California and more than one million in Georgia and Florida. More than 500,000 would lose coverage in Missouri and more than 200,000 in Mississippi and Kansas.
The new analysis predicts the coverage losses would also contribute to a “death spiral” collapse of the revamped individual insurance market and cause charity-care costs to skyrocket for hospitals and state and local governments unless new funding is provided.
The additional 29.8 million uninsured would require an extra $88 billion in uncompensated care in 2019 and an extra $1.1 trillion from 2019 to 2028, the report estimated.
The chaos would undo much of the progress the health care law has made in reducing the number of uninsured Americans. Losing federal subsidies to buy insurance would force many to simply drop their coverage.
And because healthier people would drop coverage faster, premiums would rise as insurers find a higher percentage of their customers are sick. That would leave some insurers with insufficient funds to cover claims and force others to leave the market entirely.
“To replace the ACA after reconciliation with new policies designed to increase insurance coverage, the federal government would have to raise new taxes, substantially cut spending, or increase the deficit,” the report said.
The research underscores the complex policy and political considerations that may make it difficult to repeal President Barack Obama’s signature legislation without first having a plan to replace it.
Even though Congress has voted more than 50 times to repeal the health law and President-elect Donald Trump has vowed to sign legislation to do that when he takes office next month, Obamacare advocates say doing away with ACA will be easier said than done.
In January, Congress passed a reconciliation bill repealing large portions of the Affordable Care Act with federal budget implications. But Obama vetoed the measure.
With Republicans soon to control the House, Senate and White House, GOP lawmakers could pass a similar reconciliation bill in early 2017.
Doing so would allow them to eliminate the ACA’s Medicaid expansion, federal funding to help purchase marketplace coverage and the individual and employer mandates that require most individuals to purchase health coverage and certain employers to provide coverage or face financial penalties.
Because the previous GOP reconciliation bill delayed repeal of most budget-related ACA provisions for two years, the Urban Institute analysis does likewise, projecting the cost and coverage changes of a 2017 reconciliation bill to 2019.
To the delight of fiscal hawks, a reconciliation bill repealing the ACA would cause federal health care spending for children and working-age adults to shrink by $109 billion in 2019 and by $1.3 trillion over the years from 2019 to 2028 as the Medicaid expansion, premium tax credits and cost-sharing assistance disappear.
States would also cut their spending for Medicaid and the Children’s Health Insurance Program by $4 billion in 2019 and by $76 billion from 2019 to 2028.
But the savings would be offset in part by the cost of uncompensated care, the analysis said. The federal government would likely spend $23 billion for charity care in 2019 and $262 billion from 2019 to 2028, according to the analysis. State and local governments would pay $14 billion for charity care in 2019 and $164 billion the following decade.