The Potential Effects of a Supreme Court Decision to Overturn the Affordable Care Act

A diabetic man tests his blood sugar with a blood glucose meter.

Using projections of coverage and spending in 2022 that account for an anticipated partial economic recovery from the COVID-19 recession, researchers estimate overturning the Affordable Care Act (ACA) would leave an additional 21 million people uninsured.

The Issue

The U.S. Supreme Court is expected to hear arguments on the constitutionality of the ACA in California v. Texas on November 10, 2020. The plaintiffs argue that the entire law should be found unconstitutional and overturned, given a 2017 tax law set the ACA’s individual mandate penalties to $0 but stopped short of eliminating the individual mandate language included in the ACA.

Key Findings

The uninsurance rate for nonelderly people in the United States would climb nearly 70 percent if the ACA is overturned by the U.S. Supreme Court. Researchers also predict disproportionate coverage losses among certain racial and ethnic groups.

  • More than 21 million individuals, one million more than prior estimates, could lose their health insurance coverage.

  • Among both non-Hispanic Black and white people, the uninsurance rate is expected to increase nearly 85 percent (to 20% of Blacks and 15% of whites) Among Hispanic people, the increase would be nearly 40 percent (to 30%).

  • Federal health care spending would fall $152 billion annually and the amount of uncompensated care sought by the uninsured would rise 74 percent.

Researchers utilized the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to arrive at their findings. HIPSM is a comprehensive microsimulation model of the health insurance system that allows researchers to estimate cost and coverage implications of health policy decisions with real world data.


If the court sides with Texas and eliminates the ACA, the consequences will be felt throughout the U.S. health care system, with massive financial consequences for health care providers and households. Overturning the ACA would leave millions of people with reduced access to necessary medical care.

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.