Today, we build on this work to show the areas of the country most vulnerable to losing health coverage options once the full impact of ACA repeal begins. In the year this happens—most likely 2020—CBO estimates that 50 percent of the nation’s population will live in an area where not a single insurance company offers Marketplace coverage. Coupled with the repeal of the ACA’s Medicaid expansion and premium tax credits in the same year, 27 million people could lose their source of coverage.
Risk assessment based on the authors’ analysis of CBO projections and 2017 insurer participation by county and medicaid expansion status by state.
The map identifies the counties most likely to be hard hit by “repeal and delay” in the likely first full implementation year (2020). The areas marked in red on the map depict counties that are most vulnerable to have zero Marketplace options and to lose their Medicaid expansion coverage. The areas marked in orange on the map show counties most likely to experience either a complete loss of Marketplace options, or a loss of Medicaid expansion coverage. The areas marked in yellow on the map are counties that we estimate will be least affected by loss of Marketplace insurance and the reversal of Medicaid expansion.
It is important to point out that, while counties where only one or two insurers currently participate in the Marketplaces are most at risk, even counties where three insurers currently compete will be at risk by 2020, when 50 percent of the nation’s population is implicated.
This map is merely an illustration of what could happen; results could be different, because greater or fewer insurers could drop out of the system, and some states could seek to continue their Medicaid expansion with state funding (although doing so is likely prohibitively expensive). That said, the map underscores that if “repeal and delay” becomes law, without a subsequent bill to replace the ACA, some Americans may literally have no private plan to enroll in, and no Medicaid coverage option—which breaks the promise to not “pull the rug out from under people.”
Jeanne Lambrew, PhD, is a senior fellow at The Century Foundation and an adjunct professor at the NYU Wagner Graduate School of Public Service. Her writing, research, and teaching focus on policies to improve health care access, affordability, and quality.
Ellen Montz was a senior fellow at The Century Foundation with expertise in U.S. health care policy, with a specific research focus on health insurance coverage and market regulation. She is currently a PhD candidate in health policy, with a concentration in economics, at Harvard University.
Simon Glenn-Gregg is the Interactive Lead at The Century Foundation. He manages TCF's digital platform and focuses on making its data engaging. He also writes about issues of affordable housing, health care reform and concentrations of poverty.
Where Health Care Options Could Disappear Under ACA “Repeal and Delay”
Despite growing opposition and missed deadlines, Congress continues to pursue “repeal and delay” of the Affordable Care Act (ACA). Last month, the Congressional Budget Office (CBO) estimated the devastating impact of such legislation. In previous Century Foundation posts, we translated CBO’s projections into dollar amounts of increased premiums for young adults and a map showing counties at risk of losing their only insurance option as soon as next year.
Today, we build on this work to show the areas of the country most vulnerable to losing health coverage options once the full impact of ACA repeal begins. In the year this happens—most likely 2020—CBO estimates that 50 percent of the nation’s population will live in an area where not a single insurance company offers Marketplace coverage. Coupled with the repeal of the ACA’s Medicaid expansion and premium tax credits in the same year, 27 million people could lose their source of coverage.
The map identifies the counties most likely to be hard hit by “repeal and delay” in the likely first full implementation year (2020). The areas marked in red on the map depict counties that are most vulnerable to have zero Marketplace options and to lose their Medicaid expansion coverage. The areas marked in orange on the map show counties most likely to experience either a complete loss of Marketplace options, or a loss of Medicaid expansion coverage. The areas marked in yellow on the map are counties that we estimate will be least affected by loss of Marketplace insurance and the reversal of Medicaid expansion.
It is important to point out that, while counties where only one or two insurers currently participate in the Marketplaces are most at risk, even counties where three insurers currently compete will be at risk by 2020, when 50 percent of the nation’s population is implicated.
This map is merely an illustration of what could happen; results could be different, because greater or fewer insurers could drop out of the system, and some states could seek to continue their Medicaid expansion with state funding (although doing so is likely prohibitively expensive). That said, the map underscores that if “repeal and delay” becomes law, without a subsequent bill to replace the ACA, some Americans may literally have no private plan to enroll in, and no Medicaid coverage option—which breaks the promise to not “pull the rug out from under people.”
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Tags: health care, aca, affordable care act, obamacare, health insurance, healthcare.gov