The Cost of ACA Repeal

Twenty-four million more people would become uninsured by 2021 if the Affordable Care Act (ACA) is repealed following the 2016 election.

The Issue

The report finds that 14.5 million fewer people would have Medicaid coverage by 2021, 8.8 million fewer people would have marketplace or other nongroup insurance and 700,000 fewer people would have insurance through their jobs if the ACA is repealed.

Key Findings

  • The number of uninsured people would more than double (107.0% increase) in Medicaid expansion states, and increase by 56.9 percent in states that have not expanded.

  • Eighty-one percent of those losing coverage would be in working families; around 66 percent would have a high school education or less; 40 percent would be young adults; and about 50 percent would be non-Hispanic whites.

  • There would be 14.5 million fewer people with Medicaid coverage.

  • There would be 8.8 million fewer people enrolled in private nongroup health insurance.


Between 2017 and 2026, following a potential repeal, federal health care spending would decrease by $927 billion; however, state spending would increase by $68.5 billion over the same period as more people receive uncompensated care due to the increase in the number of people without insurance.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.