State-by-State Coverage and Government Spending Implications of the Better Care Reconciliation Act and American Health Care Act

A medical professional helps patients fill out forms for medical insurance.

By 2022, 24.7 million Americans could lose health insurance under BCRA and 23.0 million under AHCA.



The Issue

Research finds that 24.7 million more Americans could be uninsured by 2022 under the Senate-introduced Better Care Reconciliation Act (BCRA) and 23.0 million under the House-passed American Health Care Act (AHCA).

Key Findings

  • By 2022, federal Medicaid funding under the BCRA would decrease by $102.2 billion.

  • By 2022, federal Medicaid funding under the AHCA would decrease by $105.4 billion.

  • States that had the largest coverage gains under the Affordable Care Act would have the largest increases in the number of uninsured residents under both the BCRA  and the AHCA, including California (increase from 9.0% uninsured to 21.4% under BCRA and 21.2% under AHCA) and Ohio (increase from 6.5% uninsured to 18.4% under BCRA and 17.7% under AHCA).


Of the 24.7 million additional uninsured under the BCRA in 2022, 76 percent would have incomes below 400 percent of the federal poverty level (FPL)—11.9 million would have incomes below 138 percent of FPL, and 6.9 million would have incomes between 138 and 400 percent of FPL. Under the AHCA, 80 percent of the 23.0 million additional uninsured Americans would have incomes below 400 percent of FPL.

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.