Partial ACA repeal could increase uninsured by 32M

The number of uninsured individuals would rise by 18 million in the first new plan year after the enactment of a partial Affordable Care Act replacement, according to a new report from the Congressional Budget Office.

Enacting even a partial repeal of the Affordable Care Act could increase the number of uninsured Americans by 32 million within a decade, according to the Congressional Budget Office.

The CBO and the staff of the Joint Committee on Taxation made that estimate in a newly released report they prepared at the request of a handful of Democratic leaders in the Senate. The report looked at what would happen after the enactment of legislation modeled on a previously vetoed bill, which would have eliminated the ACA’s individual mandate penalties and subsidies, but preserved its insurance market reforms.

Using the blueprint established by that failed repeal attempt, the Senate and House have already passed a budget resolution that instructs key committees to draft legislation that would dismantle the ACA by Jan. 27.

The report said the number of uninsured individuals would rise by 18 million in the first new plan year after the enactment of such a partial ACA replacement. The number of uninsured would eventually rise by 27 million, then 32 million by 2026, after subsidies for marketplace plans and Medicaid expansion disappear.

While most of the coverage reductions would result from the disappearance of individual mandate penalties, the agencies also said they expect insurer exits from the individual market to play a role.

In addition, the report estimated that premiums in the individual market would rise by 20-25%, relative to projections under the ACA, in the first new plan year after the bill is enacted. By 2026, premiums would roughly double.

This, too, would largely stem from repealing the individual mandate penalties, as it would lead to fewer—as well as older and sicker—enrollees, forcing insurers to raise premiums to cover their rising costs. Declining competition due to fewer insures operating in the marketplaces also could be a factor in raising premiums, according to the report.