If the entire Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) were eliminated, the number of uninsured would increase by 50 percent, or 17.1 million people, in 2019, according to an analysis by the Urban Institute. Invalidating the entire ACA would, it concluded, cause "considerable harm," even compared with the ACA as restructured by recent policy changes, including the recent repeal of the individual mandate penalties.
The Tax Cuts and Jobs Act of 2017 (P.L. 115-97) eliminated the tax penalty only of the ACA’s individual mandate (see ACA Secs. 1411, 1501). With no remaining legitimate basis for the ACA, argued 20 states in Texas v. United States, No. 4:18-cv-00167-O, the remainder of the law must also fall (see 20 states seek repeal of entire ‘unconstitutional and irrational’ ACA, February 28, 2018). On June 7, 2018, Attorney General Jeff Sessions announced that the Department of Justice will not defend the constitutionality of the individual mandate (see Sessions announces DOJ will not defend the constitutionality of the individual mandate, June 13, 2018).
According to the Urban Institute, if the ACA were invalidated, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) would decrease by 15.1 million in 2019 due to the elimination of the ACA’s Medicaid expansion. The number of people with private nongroup insurance would drop from 14.0 million to 10.4 million, and those retaining coverage would likely have fewer benefits and pay more out of pocket. In addition, federal spending on Medicaid and marketplace premium tax credits would fall from $392.1 billion to $245.5 billion in 2019.
The Urban Institute did not analyze the elimination of other ACA provisions that affect the Medicare program, payment, and delivery system reforms, support for community health centers, and preventive care initiatives.
Companies: Urban Institute
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