With ACA Nullified, Uninsurance Rate Will Soar 70%

A Robert Wood Johnson study estimates that 21 million people would lose health insurance coverage if the U.S. Supreme Court overturns the ACA.

A U.S. Supreme Court ruling nullifying the Affordable Care Act would result in the uninsurance rate for nonelderly people climbing nearly 70%, with 21 million Americans losing coverage, according to a new study commissioned by the Robert Wood Johnson Foundation.

"Invalidating the ACA would be devastating to millions, especially people who gained access to affordable health coverage in the past decade," said Avenel Joseph, vice president for policy at the Robert Wood Johnson Foundation.

"Nearly overnight, America's health care system could become more expensive and less accessible and perpetuate health and financial insecurity. Unfortunately, those who have the least stand to lose the most," Joseph said.

The Supreme Court has scheduled oral arguments for November 10 on the constitutionality of the ACA in the consolidated California v. Azar and Texas v. Azar lawsuits, but a ruling is not expected until mid-2021 at the earliest.

The plaintiffs in both cases are asking the justices to rule on the constitutionality of the individual mandate without a tax mandate, and whether the mandate is severable, and the rest of the law can remain in place.

The study suggested that if the high court nullifies the ACA, the lost coverage would disproportionately hurt "certain racial and ethnic groups" For both non-Hispanic Black and white people, the uninsurance rate is expected to increase nearly 85% (to 20% of Blacks and 15% of whites). Among Hispanics, the increase would be nearly 40% (to 30%).

Poor people in states that expanded Medicaid access would also be disproportionately affected, with Maine, Kentucky, and West Virginia seeing their uninsurance rates nearly triple.

If the ACA is overturned, the study also estimated that federal health care spending would fall $152 billion annually and the amount of uncompensated care sought by the uninsured would rise 74%.

To get their estimates, the researchers tapped the Urban Institute's Health Insurance Policy Simulation Model, a microsimulation model of the health insurance system that allows researchers to estimate cost and coverage implications of health policy decisions.

The analysis takes into account projections that the United States will have partially recovered from the COVID recession as of 2022.