Partial ACA repeal could leave nearly 30M more uninsured

If Republicans move forward with a partial repeal of the Affordable Care Act through budget reconciliation, the ranks of the uninsured could swell to nearly 60 million.

Using a blueprint from a similar measure passed by Congress last year and vetoed by President Barack Obama, Republicans could repeal significant elements of the healthcare reform law during budget reconciliation early next year. Indeed, Senate Majority Leader Mitch McConnell said Tuesday that repealing the ACA will be the first order of business in the Senate in January, according to Reuters.

That would mean only elements of the law that are tied to the federal budget would be repealed, including Medicaid expansion and federal assistance for ACA marketplace coverage. But it would still drastically cut the number of insured people and spending on government assistance programs like the Children's Health Insurance Program, according to an analysis from the Urban Institute.

Should the ACA repeal effort proceed during the budgetary process, the number of uninsured people would more than double from 28.9 million to 58.7 million by 2019, according to the analysis. That would include 22.5 million who would lose their coverage as a result of cutting premium tax credits, Medicaid expansion or the removal of the individual mandate. In addition, the removal of the individual mandate could spur even more insurers to pull out of the exchanges by 2018, potentially leaving an additional 7.3 million patients uninsured.

“This scenario does not just move the country back to the situation before the ACA,” according to the report. “It moves the country to a situation with higher uninsurance rates than was the case before the ACA’s reforms.”

The Urban Institute projects that about 82% of those newly uninsured individuals would be working class citizens, about 80% of adults losing insurance would not have college degrees. Nearly 60% would be non-Hispanic whites, according to the analysis.

The analysis also estimates that state spending on Medicaid and CHIP would drop by $76 billion between 2019 and 2028 due to the eliminated ACA provisions. This would be coupled with increased financial pressure on providers and state and local governments to provide uncompensated care, to the tune of as much as $1.1 trillion during that same window.