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Stephanie Pellitt

Policy and Advocacy Associate

CBO Estimates Dramatic Increases In Uninsured, Premiums with ACA Repeal

January 19, 2017 | ACA | Comments
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The Congressional Budget Office (CBO) released a report on Tuesday estimating dramatic increases in the number of uninsured people and in monthly premium costs if Congress repeals the ACA with legislation similar to last year’s repeal efforts. The report found that in the first year after repeal, the number of uninsured would increase by 18 million, premiums would increase between 20-25 percent, and that half of the nation’s population would live in an area with no insurer participation in the individual market. CBO’s estimate does not consider coverage or premiums resulting under any transitional or replacement policies that could be passed along with or soon after an ACA repeal bill.

CBO’s projections were based on that legislation that would have eliminated insurance mandate penalties and would have eliminated the ACA’s expansion of Medicaid eligibility and the ACA premium subsidies after a two year delay.

In the absence of a replacement plan, key takeaways from CBO’s projections include:

  • Effects on Insurance Coverage – In the first full plan year following enactment, CBO projects about 18 million people would become uninsured. This would consist of “about 10 million fewer people with coverage obtained in the nongroup market, roughly 5 million fewer people with coverage under Medicaid, and about 3 million fewer people with employment-based coverage.” CBO anticipates this reduction of coverage would stem from a lack of insurer participation in the nongroup market as well as repeal of the individual mandate.
  • Effects on Premiums – In the first plan year after enactment, CBO estimates that “premiums in the nongroup market would be roughly 20 percent to 25 percent higher than under current law once insurers incorporated the effects of H.R. 3762’s changes into their premium pricing.”
  • Long-term Effects on Coverage – After Medicaid expansion repeal is implemented, CBO estimates that “the number of people without health insurance coverage [would increase] by about 27 million in the year following the elimination of the Medicaid expansion and marketplace subsidies and by 32 million in 2026, relative to the number of uninsured people expected under current law.”
  • Effects on Insurer Participation – If the repeal bill is enacted, CBO estimates that “about half of the nation’s population lives in areas that would have no insurer participating in the nongroup market in the first year after the repeal of the marketplace subsidies took effect, and that share would continue to increase, extending to about three-quarters of the population by 2026.”

Members of Congress have expressed their commitment to creating an ACA replacement plan that would mitigate some of these effects. However, without details of the replacement plan, advocates remain concerned about potential threats to health care access.