President Donald Trump has vowed to make significant changes to the Affordable Care Act (ACA), also known as Obamacare. While it is unlikely to be repealed, some of the changes that have been proposed could significantly weaken the law and harm the people who currently are insured through their employer, the Marketplace, or Medicaid. So what happens if the Affordable Care Act goes away?
Background
The ACA went into effect in 2014. In 2013, roughly 44 million people in the United States were uninsured. As of 2023, there were 25.3 million people who were uninsured in the U.S., which represents 9.5% of the U.S. population, an historic low. Reasons for lack of insurance coverage include the high cost of insurance for people with low-income despite subsidies, lack of Medicaid expansion to people with low-income in some states, undocumented status, and lack of access to the health care exchanges.
Effects of Repeal
If the ACA is repealed, 29.8 million people could lose their health insurance coverage, more than doubling the number of people without insurance. In Kentucky, it could mean the number of uninsured people in the state would increase by 486,000 people (200%). In addition, because people would have less discretionary income due to higher out-of-pocket costs for medical care, there may be less spending on groceries, etc., and a projected loss of 2.9% of jobs in Kentucky.
Prior to implementation of the ACA, nearly 20% of people applying for individual insurance were denied coverage; some insurers had denial rates of over 40% or more. It is estimated that as many as 133 million people with pre-existing conditions could lose protection if the ACA is repealed and could possibly be denied coverage altogether. Under the ACA, children have been allowed to remain on their parents’ insurance until age 26, a benefit that could also be lost, resulting in more young people without insurance coverage.
Without access to health insurance, people may be forced to choose between medications, doctor’s visits, and feeding their families. Many more may delay or avoid care, which will most certainly result in worsened health care outcomes.
In addition to poor individual health outcomes and worsened individual and community financial stability if Obamacare is repealed, the health care system also is likely to suffer. It is estimated that hospitals would receive $600 billion less, and funding for such services as outpatient medical care would fall by $1.1 trillion if the ACA is repealed, while demand for uncompensated care will rise. This could result in significant stresses on hospitals and practices. Rural hospitals already face financial challenges and could be left at greater risk of closure, worsening access to timely medical care for the communities they serve.
Conclusion
In summary, the ACA has provided more people with access to affordable care, especially in those states that chose to expand Medicaid, including Kentucky. Dismantling it without a better replacement would result in tens or even hundreds of millions of people lacking access to health care coverage, with resulting declines in their personal health and financial security, as well as destabilizing the health care system, particularly in rural and underserved areas.