Repeal of ACA Would See Uncompensated Costs, Unmet Needs Soar

Partial repeal of the Affordable Care Act would result in 29.8 million people losing their coverage and an increase in spending on uncompensated care of $1.1 trillion over ten years, an issue brief from the Urban Institute finds.

Funded by the Robert Wood Johnson Foundation, the brief, The Impact on Health Care Providers of Partial ACA Repeal Through Reconciliation (18 pages, PDF), estimates that if Congress moves forward with partial repeal of the ACA through a budget reconciliation bill similar to the one President Obama vetoed last January, approximately thirty million more people could wind up uninsured by 2019. And many of those people would require more uncompensated care than federal and state governments are expecting to provide, leaving healthcare providers with an additional financial burden.

A partial repeal modeled on the January 2016 reconciliation bill would eliminate the expansion of Medicaid that has occurred under the ACA, the legislation's individual and employer mandates, and marketplace premium tax credits and cost-sharing reductions, while maintaining insurance market reforms, including essential health benefit requirements and prohibitions on pre-existing condition exclusions. As a result, the brief argues, the private non-group market would rapidly unravel, leaving more people without health coverage than if the ACA had never been implemented and resulting in additional uncompensated care costs of some $88 billion. Indeed, additional spending for uncompensated care could total $1.1 trillion by 2028, the brief suggests, while federal funding for such care would increase no more than $35 billion over the ten-year period.

Given that the Republican-controlled Congress is expected to seek additional spending cuts, and that state and local governments are unlikely to raise taxes to cover any increase in uncompensated costs, the brief suggests that partial ACA repeal could lead to a fourfold increase in the amount of uncompensated care providers have to finance themselves. "As a result," it concludes, "there would likely be a substantial increase in unmet healthcare need for the uninsured."