If the U.S. appellate court invalidates the Affordable Care Act (ACA), the number of non-elderly uninsured people in the U.S. would rise to 65% of the population in 2020, according to a new analysis conducted by the Urban Institute.
The study found that those with the lowest annual incomes, as well as young adults and residents of the South and West, would be hardest hit by the repeal. Repealing the ACA’s coverage reforms—such as Medicaid expansion, income-related taxes credits, the insurance marketplaces and other health plan regulations—would increase the non-elderly uninsured rate from 11% to 18% by next year.
Specifically by state, the rate of uninsured would rise by 92% across the 34 states that have expanded Medicaid and 34% in non-expansion states. Looking at specific incomes, uninsured rates for those under 138% of the federal poverty level would rise by 71%. Among those with incomes between 138% and 200% of poverty, the uninsured rates would rise 72%.
The rates would rise the most in relative terms in the Northeast, 78%, and West, 91%—regions with more expanded Medicaid states. In the Midwest and South, uninsured rates would rise by 65% and 51%, respectively. Overall, the largest percentage point increase would occur in the West if the ACA were repealed.
People of color would be significantly impacted, according to the study. The number of uninsured non-Hispanic whites would rise by 9.4 million and rise by 3.2 million for black individuals.
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Children would be the least affected by a repeal in the ACA, as they have the most public options for insurance coverage. It is estimated that the rate of uninsured children would rise by about 1 million. The largest increase in uninsured would be among people ages 18 to 30—8.8 million people.
Overall, the report found that the largest group of people losing coverage would be U.S. citizens with high levels of English proficiency, half of which have a high school education or less. And 70% of the additional uninsured will live in the South or West regions of the U.S.
Those in support of Texas v. United States argue that the ACA should be invalidated because the Tax Cuts and Jobs Act of 2017 eliminated the ACA’s individual mandate.
“Eliminating the ACA would be a major step backward for the millions of people who gained affordable healthcare coverage this decade,” John Holahan, lead author and institute fellow at the Urban Institute, said in a statement. “Without access to the ACA’s health and financial benefits, more low- and middle-income people would face higher financial burdens and less access to necessary medical care.”
Holahan was not surprised by most of the data in this report, as it seems the ACA had the biggest impact on young adults and families living below the poverty line. Therefore, it seems fitting that these same demographics would suffer the most from an ACA repeal.
However, he was a bit surprised at how large of an impact the repeal would have on so many southern and western states, even though many do not have expanded Medicaid. But what these states did gain was an increase in market exchanges.
“So if you get rid of the ACA, you get rid of the exchanges,” Holahan told FierceHealthcare.
Ultimately, if the ACA is found unlawful, there will be an impact felt in both expansion and non-expansion states. And Holahan notes that this study spells out exactly how people would be affected. He also added the report clearly maps out who has benefited from the ACA for those who are still unaware of its impact on U.S. healthcare.