On Tuesday, November 10, the Supreme Court will hear oral arguments for California v. Texas, a case in which a group of conservative attorneys general led by the Texas Attorney General and the Trump Administration are seeking to overturn the entire Affordable Care Act (ACA).

Researchers from the Urban Institute recently projected that the number of uninsured Americans would rise by 21.1 million in 2022, an increase of 69 percent, if the entire ACA is overturned.  Medicaid and CHIP enrollment would fall by 15.5 million, a drop of 22 percent, and Medicaid expansion states would see the number of uninsured residents more than double, on average.  Uncompensated care costs incurred by health care providers would increase by 74 percent.  The Urban Institute analysis also includes detailed estimates on a state-by-state basis.

The Urban Institute has now produced more granular national and state-by-state estimates of overturning the ACA on coverage losses by age:

• Nationally, the number of uninsured children under age 19 would increase by 1.7 million or 48 percent in 2022. As my colleagues Joan Alker and Allie Corcoran have written, recent Census data already show that the number of uninsured children has increased by 726,000 between 2016 and 2019, with the child uninsured rate rising from 4.7 percent to 5.7 percent, after more than a decade of progress.  And because of the COVID-19 pandemic and related recession, according to Urban Institute estimates, another 300,000 children may be newly uninsured in 2020 (on top of any increase that would have otherwise occurred in the absence of the pandemic).
• Medicaid expansion states would account for 80 percent of the total coverage losses among children nationally, with an average increase in the number of uninsured children of 73 percent. But ten states (Arkansas, California, Iowa, Kentucky, Louisiana, Montana, Nevada, Oregon, Washington and West Virginia) would see the number of uninsured children more than double.  In fact, West Virginia would see its number of uninsured children more than triple, according to the new estimates.
• California (+352,000) and Florida (+149,000) would see the largest increases in the number of uninsured children.

There are two likely factors driving these expected increases in uninsured children.  First, research shows that when parents have health coverage, their eligible children are more likely to enroll and access needed care.  Elimination of the Medicaid expansion and the marketplace subsidies would therefore not only drive millions of low-income parents into the ranks of the uninsured but also result in many of their children, who would remain eligible for Medicaid and the Children’s Health Insurance Program (CHIP), ending up newly uninsured.  Second, about 1 million children are directly enrolled in marketplace plans and who would lose their coverage if the ACA was overturned.

In addition, the Urban Institute has also provided detailed national and state-by-state estimates of the coverage impact of overturning the ACA by race/ethnicity.  The number of uninsured American Indian/Alaska Native people would increase by 75 percent, the number of uninsured Asian/Pacific Islanders would increase by 76 percent, the number of uninsured Black non-Hispanic individuals would increase by 84 percent, the number of uninsured Hispanics would rise by 41 percent and the number of white non-Hispanic people would increase by 85 percent.