A Supreme Court Ruling Finding the Affordable Care Act Unconstitutional Would Have Widespread Negative Implications

Empty physician's office.

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 Issue

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.

Key Findings

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.

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.