Nearly 36,000 people could die every year, year after year, if the incoming president signs legislation repealing the Affordable Care Act.
This figure is based on new data from the Urban Institute examining how many people will become uninsured if the law is repealed, as well as a study of mortality rates both before and after the state of Massachusetts enacted health reforms similar to Obamacare.
In fairness, 36,000 is a high estimate of the number of deaths that will result if Obamacare is repealed, as there is some uncertainty about how congressional Republicans will repeal the law. Even in the best case scenario, however, a wholesale repeal of Obamacare may cause about 27,000 people to die every year who otherwise would have lived.
The Urban Institute examined how many people will lose insurance under one possible path for Obamacare repeal. Under the Senate’s current rules, legislation repealing regulatory reforms — such as the requirement that insurers cover people with preexisting health conditions — can be filibustered and thus effectively requires 60 votes to become law.
Meanwhile, legislation repealing the law’s fiscal provisions — including the Medicaid expansion, tax credits that help people pay their health premiums, and the law’s individual mandate (which charges higher income taxes to people without insurance) — can be enacted by a simple majority through a process known as ‘reconciliation.” For this reason, Senate Republicans are considering repeal of just the fiscal provisions in order to overcome a Democratic filibuster.
Repealing only these provisions, however, would actually be worse for Americans in the individual health insurance market than a total repeal of the law. That’s because the law’s provisions protecting people with preexisting health conditions cannot operate without the tax credits and the individual mandate.
The mandate, in particular, is essential because it encourages people to purchase health insurance before they become sick. Without it, many healthy individuals will wait until they are sick to buy insurance, effectively draining all the money out of an insurance pool they haven’t paid into. Eventually, many insurance pools would simply collapse.
“For every 830 adults gaining insurance coverage there was one fewer death per year.”
Urban estimates that, if congressional Republicans repeal only the fiscal provisions of the law, “the number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people (103 percent).” Of these nearly 30 million newly uninsured Americans, “22.5 million people become uninsured as a result of eliminating the premium tax credits, the Medicaid expansion, and the individual mandate. The additional 7.3 million people become uninsured because of the near collapse of the nongroup insurance market.”
Notably, this would be “a higher rate of uninsurance than before the ACA because of the disruption to the nongroup insurance market.”
The Massachusetts study examined how much mortality rates dropped after that state enacted its Obamacare-like reforms in 2006. It estimated that “for every 830 adults gaining insurance coverage there was one fewer death per year.” Applying this formula to Urban’s estimation that nearly 30 million people will become uninsured if the fiscal provisions of Obamacare are repealed indicates that about 36,000 will result ever year from such a repeal.
Alternatively, should Congress repeal the entire law, thus avoiding the collapse of many health insurance markets that will result from partial repeal, an estimated 22.5 million people will still become uninsured. In that scenario, the Massachusetts study suggests that more than 27,000 people will die every year who otherwise would have lived.
It’s also worth noting that the 22–30 million people who will lose health insurance if Obamcare is repealed are only a fraction of the people who would become uninsured under congressional Republicans’ full health care agenda. In 2015, 70 million Americans were enrolled in Medicaid, and only a small fraction of them were enrolled through the Affordable Care Act’s Medicaid expansion. Yet legislation pushed by Speaker Paul Ryan would cut all Medicaid funding between a third and a half.
Ryan also wants to repeal Medicare and replace it with a voucher program that would drive up out-of-pocket costs for seniors by an estimated 40 percent.
These two proposals, if enacted, would likely result in hundreds of thousands more deaths over the course of just a few years.