- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Discontinuation of ACA Subsidies Will Leave Many Uninsured: Ciara Zachary, PhD, MPH
The uninsured rates may skyrocket when Medicaid work requirements go into effect and if the Affordable Care Act (ACA) subsidies are not extended.
Ciara Zachary, PhD, MPH, assistant professor in the Department of Health Policy and Management at the Gillings School of Global Public Health at the University of North Carolina, explained how many individuals would be left uninsured if the Affordable Care Act (ACA) subsidies are not extended. Combined with the introduction of work requirements to be eligible for Medicaid, this could leave more than 10 million without insurance and bring the country back to pre-ACA levels of insurance coverage.
This transcript has been lightly edited for clarity; captions were auto-generated.
Transcript
What will occur if both the ACA subsidies end and the work requirements go into effect in 2027?
I think the immediate concerns are about the subsidies and the additional financial help that these subsidies had. I think we are seeing lots of reporting, whether that is from media outlets or other health policy researchers, just predicting that the price of premiums is just going to skyrocket and making health care just unaffordable for so many folks who've become reliant on the ACA, because it is comprehensive care, it is more affordable, and you kind of take that away. And thinking about other economic priorities that folks have, we hear a lot about the price of groceries, putting gas in your car, other things that people have to do just to maintain their livelihood.
I, unfortunately, think that some people might try to forego health care. And especially some of our healthier folks who might not have complex or extreme health needs, they may say, "I don't need health care." And we know what this can do to the risk pool and perhaps some destabilization of the marketplace that could further increase costs down the line. If the subsidies are not extended, we know that we'll immediately see a significant surge in the number of uninsured. Then, when you add that to the Medicaid work requirements, and how many folks may lose coverage just because of paperwork, not even deeming them ineligible, we may get to pre-ACA levels of the percentage of folks who are uninsured in this country. And I think some folks may think we might even exceed that number.
