Taken together, three recent papers provide a sobering look at the extensive economic consequences for providers if the Affordable Care Act (ACA) is repealed. Just last week, the Robert Wood Johnson Foundation published “The Impact on Health Care Providers of Partial ACA Repeal through Reconciliation,” an analysis from the Urban Institute.
Their main finding? Repeal of the ACA means spending on uncompensated care (care needed and delivered to the uninsured either free or at a sliding scale rate) would increase by $1.1 trillion over the next 10 years. Just ending people’s health coverage doesn’t mean their health needs go away. They will receive some care – although not all they need. And what care they get, whether in hospital emergency rooms or community health clinics, will have to be paid for by someone. As a result the foundation report notes, “Financial burdens on state and local governments, health care providers, and the uninsured themselves would likely rise dramatically.”
Add this analysis to the December report from the American Hospital Association estimating the effects of ACA repeal – based on the bill passed last year by Congress and vetoed by President Obama. This report estimates hospital losses alone of at least $165.8 billion over eight years and – if Medicare provider payments were not restored – additional losses of $289.5 billion.
Finally, a report last week from George Washington University’s Milken Institute estimates nationwide job losses from repeal to be 2.6 million by 2019, rising to almost 3 million lost by 2021 – and almost all of these jobs are in the private sector.
Billions of dollars in losses for hospitals. Over a trillion dollars in uncompensated care delivered that Medicaid or marketplace health coverage would once have paid for. Costs shifted onto state and local taxpayers, higher premiums in private health plans, and more hospitals and health clinics asked to shoulder the burden of uninsured people who need care. And perhaps the least surprising finding: Less spending on health care services translates into massive job losses. The research on the effect of repeal of the ACA continues to be sobering.