Legal, Policy

Report: 21M people could lose insurance if ACA is overturned

With a new nominee as the Supreme Court prepares to hear a case that could determine the future of the Affordable Care Act, the health law’s future has been thrown into question. According to the Robert Wood Johnson Foundation, the number of uninsured could increase by 70% if the ACA is overturned.

With an approaching Supreme Court hearing that could determine the future of the Affordable Care Act,  and the nomination of Amy Coney Barrett, the future of the health law has been thrown into question. If the ACA is overturned, the Robert Wood Johnson Foundation estimates that more than 21 million people could lose their health insurance by 2022, a roughly 70% increase in the uninsurance rate for nonelderly people.

Researchers used the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM), which allows them to estimate cost and coverage implications of health insurance policy decisions using real-world data.

Next month, the Supreme Court will hear California v. Texas, which raises questions about the ACA’s individual mandate. But if the court finds that the individual mandate is not severable from the rest of the ACA, it could strike down the entire law.

Though Congress stopped issuing individual mandate penalties in 2017, as part of the Tax Cuts and Jobs Act, most other parts of the law remain intact. For example, systems that allowed states to expand their Medicaid programs, requirements for insurers to cover preventive services with no co-pay, and protections to prevent insurance companies from charging people more or denying coverage because of pre-existing conditions are all still key features of the ACA.

“Invalidating the ACA would be devastating to millions, especially people who gained access to affordable health coverage in the past decade,” Avenel Joseph, vice president for policy at the Robert Wood Johnson Foundation, said in a news release. “Nearly overnight, America’s health care system could become more expensive and less accessible, and perpetuate health and financial insecurity. Unfortunately, those who have the least stand to lose the most.”

If the law were overturned, not only would these changes be difficult to undo, but they would disproportionately affect low-income patients and underrepresented groups. Some states that expanded Medicaid would have more to lose; Maine, Kentucky and West Virginia would see their uninsurance rates nearly triple, Robert Wood Johnson Foundation researchers found.

Hospitals and physician practices would also be pinched as more uninsured patients seek care. Researchers forecast a 74% increase in uncompensated care as federal health spending would decrease by $152 billion annually. These predictions take into account a partial recovery from the current recession by 2022.

In the meantime, due to the ongoing recession and the Covid-19 pandemic, more people across the U.S. are expected to get coverage through Medicaid and ACA marketplace plans. As of June, more than 500,000 people signed up for insurance through after job losses affected their coverage, and on top of that, hundreds of thousands of others enrolled through state-based exchanges. Between February and June, Medicaid and CHIP enrollment increased by 4 million.

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