Millions of people in the United States would lose health insurance coverage and access to care if the Affordable Care Act (ACA) were to be overturned. Additionally, states and care providers would face financial distress.
The U.S. Supreme Court is expected to hear arguments on the constitutionality of the ACA in California v. Texas next month. The plaintiffs argue that the entire law is unconstitutional without the individual mandate penalties.
Twenty million people would lose their health insurance if the ACA is struck down by the Supreme Court. Federally financed coverage expansions would also come to an end, including state Medicaid expansions that expanded care to more low-income residents and marketplace subsidies.
Coverage losses would be particularly pronounced among low-wage workers, nonelderly adults without a college degree, and young adult dependents on their parents’ health plans, all of whom experienced large gains in coverage under the law.
The uninsurance rate could increase to 31 percent for nonelderly Hispanic adults and to 20 percent for nonelderly Black adults if the ACA is overturned.
Eliminating state Medicaid expansions and subsidized marketplace coverage would result in massive reductions ($135 billion annually) in federal health care spending, making coverage and care less affordable for consumers and leaving providers at risk of increased uncompensated care costs.
Overturning the ACA would end popular protections, such as making sure people with preexisting health conditions can access affordable insurance coverage. Losing these guarantees means millions would likely find it impossible or extremely expensive to purchase adequate health insurance coverage in the individual market.
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Implications for Households If the Supreme Court Overturns the Affordable Care Act
An Urban brief provides an overview of how a full ACA repeal would affect average people and illustrative families in different circumstances.