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A partial repeal of health care law would leave 12 million uninsured, says report

Coast residents seeking medical care wait in line outside of Bethel Free Health Clinic in Biloxi, Mississippi in 2013. The clinic provided services for those that are uninsured or underinsured.
Coast residents seeking medical care wait in line outside of Bethel Free Health Clinic in Biloxi, Mississippi in 2013. The clinic provided services for those that are uninsured or underinsured. MCT

Some 7.6 million parents and 4.4 million children could lose health coverage in 2019 if the Affordable Care Act is partially repealed through the budget reconciliation process, according new report by the Urban Institute, a progressive, non-partisan think tank.

Likewise, the uninsured rate for parents and children would more than double in 2019 from 10.7 percent to 22.8 percent for adults. And from 4.1 percent to 9.6 percent for children under age 18, the report found.

Both 2019 estimates are higher than actual uninsured rates in 2013 before the Affordable Care Act’s main coverage provisions kicked in, the report said.

The new Urban Institute estimates are based on the previous Republican reconciliation bill that delayed for two years the repeal of most budget-related provisions in the health law. The new analysis does the same, projecting the cost and coverage changes of a 2017 reconciliation bill to 2019.

Of the 4.4 million children who would lose coverage in 2019, 88 percent would have working parents and 54 percent would be non-Hispanic whites. Among the 7.6 million uninsured parents, nearly 86 percent would be from families with at least one full- or part-time worker and 53 percent would be non-Hispanic whites.

The research reflects the consequences of repealing President Barack Obama’s signature legislation without having a plan to replace it.

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 bill in early 2017.

Senate Majority Leader Mitch McConnell, R-Ky., has said he will move to repeal the ACA when Congress returns in January 2017. Several members of Congress, including Republican House Speaker Paul Ryan, have introduced replacement plans. But passing any new plan within Congress is expected to be a hard-fought battle next year.

The previous reconciliation bill would’ve eliminated the ACA’s Medicaid expansion and federal funding to help purchase marketplace coverage. It also ended the individual and employer mandates that require most Americans to have health coverage and certain employers to provide coverage or face financial penalties.

The previous ACA repeal bill also allowed states to lower child eligibility levels for Medicaid and the Children’s Health Insurance Program (CHIP) beginning in 2017. If all states did so, another 8.9 million children would be without coverage in 2019 if the ACA is partially repealed, the report found.

The health law’s maintenance of eligibility provision also expires in 2019, allowing states to cut income eligibility levels for Medicaid and CHIP. The new report’s estimates for child coverage are based on states maintaining their current Medicaid and CHIP program eligibility for children.

But because CHIP is funded only through fiscal year 2017, the analysis also looks at coverage if no additional funding is authorized by Congress. That would allow states to eliminate separate CHIP coverage because of a lack of funding. It would also add another 3.6 million uninsured children, the report found.

A previous analysis by the Urban Institute predicted the coverage losses from a partial repeal 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.

Experts say a health law repeal by reconciliation bill could 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 likely drop coverage faster, premiums would rise as insurers are left to cover a higher percentage of sicker, costlier enrollees. That would leave some insurers with insufficient funds to cover claims and force others to leave the market entirely, experts say.

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