Dive Brief:
- If opponents to the Affordable Care Act succeed in repealing the health law after this year's presidential election, 24 million more people will become uninsured by 2021, according to a new report by researchers at the Urban Institute and funded by the Robert Wood Johnson Foundation.
- The analysis concluded by 2021, 14.5 million fewer people would have Medicaid coverage, 8.8 million fewer people would have marketplace or other nongroup coverage, and 700,000 fewer people would have employer sponsored insurance.
- The scenario would result in a total of 53.5 million uninsured people, which would be an increase of 81% from now.
Dive Insight:
The scenario warrants examination, the researchers noted, because the upcoming presidential election raises the real possibility of the health law being repealed without a replacement program or policy; such a repeal attempt made it to Obama's desk in January but the president vetoed it.
To help frame the issue, the RWJF report looked at future healthcare coverage and costs both with and without the ACA in place.
As far as coverage goes, the number of uninsured would more than double (by 107%) in Medicaid expansion states and go up by 56.9% in non-expansion states. Notably, employer-sponsored coverage is expected to decrease regardless of the presence of the ACA due to the costs of healthcare outpacing income.
As far as costs are concerned, it's a matter of where the expenses being covered under the ACA would be displaced.
"Repealing the law would transfer costs from the federal to state government, as fiscal obligations related to uncompensated care, primarily a state responsibility, would grow dramatically," wrote RWJF's Kathy Hempstead.
The researchers projected between 2017 and 2026, federal healthcare spending would go down by $927 billion while state spending would go up by $68.5 billion. Meanwhile, providers’ share of uncompensated care would shoot up by 109.2% in 2021, going from $21.3 billion to $44.5 billion--and that is assuming that government funding for uncompensated care would return to pre-ACA levels.