Understanding Who May Lose Insurance Under an ACA Repeal

With President Donald J. Trump in the White House and Republicans controlling both the House of Representatives and the Senate, the Affordable Care Act (ACA) is almost guaranteed to be repealed, or at least modified. As a result, there should be a better understanding of health and healthcare use by individuals who are at risk of losing their insurance with a repeal of the ACA, wrote authors of a letter in JAMA Internal Medicine.

“Our analysis highlights the socioeconomic vulnerability and rates of chronic diseases and healthcare utilization of individuals at risk of lose health insurance if the ACA is modified or repealed such that premium tax credits are eliminated and Medicaid expansion is rolled back,” the authors wrote.

The researchers used the Integrated Health Interview Series of the 2015 National Health Interview Survey and identified 3 groups of adults under the age of 65 who were at risk of losing their health insurance through changes to or a repeal of the ACA.

The groups were as follows:

1. Adults with incomes below 400% of the Federal Poverty Level (FPL) who purchased insurance through the ACA’s exchanges.
2. Childless adults with incomes below 138% of the FPL who are covered by Medicaid. They are newly covered by the program through the ACA’s expansion.
3. Medicaid-enrolled parents or adults in families with children with incomes 50% to 138% of the FPL.

These adults were all more likely to be minorities, poor, and unemployed compared with adults with employer-sponsored insurance. Adults who have employer-sponsored insurance are unlikely to be affected by changes in subsidies or to Medicaid.

Adults in the groups more likely to lose their insurance had higher rates of self-reported poor health and were more likely to have visited the emergency department, been hospitalized, have a high number of physician officer visits, and have certain chronic diseases.

“The serious consequences for those at risk to lose coverage if premium tax credits and Medicaid expansion are rolled back are striking,” the authors concluded. “These consequences point to the challenges Congress should address before enacting new health care legislation.”