The Affordable Care Act is currently facing one of its biggest––if not the biggest––challenge to date after a federal judge declared the healthcare law unconstitutional. The judge’s decision has led to an appeals process in the case, which stems from a Republican led lawsuit launched in 2018.
While the case is pending in the fifth circuit court, the ACA is still in place. And repealing it would have serious, immediate consequences, according to the Urban Institute, which published a brief on the potential implications of the repeal of the law.
“This would have vast consequences that would be felt throughout the U.S. healthcare system,” the brief reads.
As many as 20 million people would become uninsured if the law were repealed, with the uninsured population concentrated among the most vulnerable––people with the lowest incomes, young people, families and residents of the South and West, the brief found.
These are the populations that experienced the biggest benefits under the ACA, as many states expanded Medicaid under the law. People in the 34 states that did expand Medicaid would see a much greater negative impact from a repeal––14.2 million in these expansion states would become uninsured. Another 5.7 million more people outside these expansion states would also be uninsured.
“Eliminating the ACA would be a major step backward for the millions of people who gained affordable healthcare coverage this decade,” John Holahan, institute fellow at the Urban Institute, said in a statement. “Without access to the ACA’s health and financial benefits, more low- and middle-income people would face higher financial burdens and less access to necessary medical care.”
The vast majority—3/4–– of the people to become uninsured following a repeal would have incomes below 200% of the federal poverty level. Across demographics, 9.4 million non-Hispanic white people and 3.2 million black people would be among the uninsured, an increase of 79% each. In addition, the number of uninsured would rise 71% among people with incomes under 138% of the FPL (annual income less than $16,753 for a single adult), and 72% for those with incomes between 138% and 200% of the FPL (annual income between $16,753 and $24,280 for a single adult).
While the South and West are a mix of states that expanded Medicaid and those that did not, about 70% of the additional uninsured would live in these areas. That’s because even if they didn’t qualify for Medicaid, many lower-income people gained insurance through the individual marketplaces.
The case hinges on the fact that Congress zeroed out the individual mandate in the 2017 Tax Cuts and Jobs Act, effectively eliminating the tax for not having insurance. Without that tax, the entire law cannot be upheld, according to arguments from Republicans in the case. The Trump administration has agreed, with the Department of Justice taking the extraordinary step of not defending the healthcare law in the suit. Instead, Democratic states have stepped in as defendants.