Reports shows catastrophic rise in uninsured rate should Affordable Care Act be repealed
Total number of uninsured would swell to 53.5 million people, an increase of 81 percent under current law, if ACA were undone.
Data shows that 24 million more people would become uninsured by 2021 if the Affordable Care Act is repealed following the 2016 election, according to a new report.
Authored by researchers at the Urban Institute with funding from the Robert Wood Johnson Foundation, the report finds that 14.5 million fewer people would have Medicaid coverage by 2021, 8.8 million fewer people would have marketplace or other nongroup insurance, and 700,000 fewer people would have insurance through their jobs. This would bring the total number of uninsured to 53.5 million people, an increase of 81 percent under current law.
Researchers also discovered that 81 percent of those losing coverage would be in working families, around 66 percent would have a high school education or less, 40 percent would be young adults and about 50 percent would be non-Hispanic whites. They also said that many states have reported net budget savings as a result of expanding Medicaid and would experience budget shortfalls if the ACA were repealed. Meanwhile, significantly less healthcare would be provided to modest- and low- income families.
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Among the 24 million people who would lose coverage by 2021, more than 63 percent would have incomes below 200 percent of the federal poverty level. About 81 percent of those losing coverage would be in working families, and about 66 percent would be in families with at least one full-time worker. Nearly two-thirds of those losing coverage would have a high school education or less, and about 40 percent of those losing coverage would be young adults aged 18 to 34.
Households would spend $28.9 billion less on their own healthcare without the ACA, a decrease of 4.9 percent, primarily because fewer people would have health coverage, the report found. However, the effect varies by income. Households below 100 percent of the federal poverty level would see their spending on healthcare increase 5.9 percent without the ACA, households with incomes between 100 and 200 percent of FPL would see their spending on healthcare decrease 0.8 percent without the ACA, and those with higher incomes would see larger reductions in health care spending. These reductions in healthcare spending occur because more people enroll in health coverage under the ACA and many contribute to insurance premiums and pay directly out-of-pocket for some portion of the care they receive, and they use more care when insured.
[Also: Affordable Care Act helps bolster ranks of insured lower-income children, study says]
Providers would pay for more uncompensated care if the law were repealed, researchers said, because they would ultimately absorb uncompensated care that is not funded by federal, state or local governments. The report estimates that the providers' share of uncompensated care would increase 109.2 percent in 2021 if the ACA were repealed, from $21.3 billion to $44.5 billion. That assumes that governments would be willing to fund uncompensated care at pre-ACA levels. If governments did not return to pre-ACA levels of uncompensated care funding, the increase in the burden on providers would be higher, as would the unmet need for care.
In addition to looking at the number of people who would lose coverage if the law was repealed, the researchers also examined what it would mean for federal and state spending on healthcare. Between 2017 and 2026, following a potential repeal, federal healthcare spending would decrease by $927 billion; state spending, however, would increase by $68.5 billion over the same period as more people receive uncompensated care.
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The authors were quick to note that their analysis may be incomplete, with factors that could exacerbate the findings. The individual mandate, for example, could have a larger effect on people's behavior than it has so far, they said; this would lead to more private coverage under the ACA than simulated in the report, and a correspondingly larger loss of coverage under repeal.
Twitter: @HenryPowderly
