30 Million Americans Could Lose Coverage Under ACA Repeal

The Urban Institute released a report today which examines the effects of a proposed partial repeal of the ACA. The GOP is proposing to repeal the ACA through a budget reconciliation process, which requires only a simple majority in the Senate and cannot be filibustered.

The components of the ACA that are at risk include:

• Elimination of Medicaid expansion
• Financial assistance for Marketplace coverage, including premium tax credits and cost-sharing reductions
• Individual and employer mandates

The model shows changes that would start in 2019 for a “repeal without replacement” plan under the above conditions. Notably, the report predicts an increase of 103% more uninsured individuals nationally, from 28.9 million to 58.7 million people. The majority of the expected uninsured — or 82% — are working families who will no longer be able to afford coverage. 56% of these individuals are white, non-Hispanic Americans.

The report also breaks down these numbers by state: there will be an anticipated 146% more uninsured in California, for instance, a state that expanded Medicaid under the ACA, and 90% more in Florida, a state that did not expand Medicaid.

Medicaid/CHIP coverage is expected to drop by 13 million people. Due to the loss of the individual mandate, anticipated increases in the cost of coverage, and reduced premium tax credits to participate in the Marketplace, private non-group coverage is expected to drop significantly as well. Insurers are predicted to further drop out of offering both Marketplace and non-Marketplace coverage.

Additionally, the House vs. Burwell case may remove another layer of financial assistance to reduce costs for healthcare. The House of Representatives has sued departments and officials in the executive branch, including HHS Secretary Sylvia Burwell, on the grounds that President Obama acted illegally to divert federal tax refunds in implementing the ACA; the key provision affecting patients is the end of funds for cost-sharing reductions from insurance companies.

A “Week of Action,” led by Families USA, Doctors for America, Community Catalyst, and a coalition of state- and community-based organizations, is in the works for next week. Stay tuned for our upcoming Collective Action Alerts, which will support these efforts to protect patients’ access to affordable healthcare.

In the meantime:

• Join us in contacting your Senators, who reconvene on January 3, to oppose a “Repeal without Replace” plan. We need to make sure that our representatives understand the implications of the proposal to repeal the ACA without a replacement plan
• Use your networks and social media, and support organizations like Enroll America to expand coverage before Open Enrollment ends December 15. Help patients get covered!
• Sign Families USA’s petition to Keep America Covered

Jane M. Zhu, MD, MPP