How many would lose coverage if the #ACA is struck down in YOUR Congressional District? (updated for the #COVID19 era)

UPDATE 9/29/20: There have been several important developments in the #TexasFoldEm case since I posted this back in June.

For one thing, another 81,000 Americans have died of COVID-19 and another 4.7 million Americans have tested positive for it.

For another, Supreme Court Justice Ruth Bader Ginsburg has passed away, and Donald Trump has already formally nominated an ultra-right wing zealot who is on the record as wanting the ACA to be struck down to replace her. His nominee's confirmation hearings have already been scheduled to start in mid-October, meaning that there's a very good chance that she'll be confirmed by the GOP-controlled Senate before Election Day...in which case the Texas Fold'em case to strike down the entire ACA could end up being the very first case she hears as a U.S. Supreme Court Justice on November 10th.

With this in mind, I figured this would be a good time to re-up the analysis below.

In March 2019, Linda J. Blumberg, Matthew Buettgens, John Holahan and Clare Wang Pan of the Urban Institute ran a detailed analysis to determine what the impact on healthcare coverage would be in every state if the Texas vs. U.S. lawsuit (aka Texas vs. Azar or #TexasFoldEm) caused the Patient Protection & Affordable Care Act (ACA) to be repealed with immediate effect.

They also attempted to calculate how much federal funding every state would lose each year if the ACA were to be repealed as a result of the absurd Texas vs. U.S. (aka #TexasFoldEm) lawsuit. Nationally, they concluded that the U.S uninsured rate would increase by nearly 20 million people, while the 50 states (+DC) would collectively lose out on nearly $135 billion in federal funding.

Last summer, I worked with CAP analysts Emily Gee and Nicole Rapfogel to break out the Urban Institute's state-level estimates into all 435 Congressional Districts (CDs). Separately, I ran my own projections of how much of that $135 billion in annual funding each Congressional District stood to lose if the ACA is struck down.

However, all of those projections were done before the COVID-19 pandemic hit the United States. Since the beginning of 2020, the entire U.S. healthcare industry, including both private health insurance as well as public programs like Medicare, Medicaid and CHIP, have been thrown into disarray, as over 40 million Americans have lost their jobs, hospital resources have been overwhelmed and the economy has tanked.

Therefore, last week, Gee and Rapfogel put together updated & revised projections of just how many people are projected to lose their healthcare coverage (both private and public) if the Trump Administration and Republican Party are successful in convincing the U.S. Supreme Court to strike down the entire ACA this fall. They concluded that the total number of Americans who would lose their coverage would increase by nearly 3.4 million additional people nationally (around 17% higher than the prior estimate), ranging from an 8.4% increase in New Mexico to a whopping 181.8% increase in Hawaii. They include their methodology at the link.

Gee & Rapfogel's updated estimates only break the numbers out at the state level, so I decided to take it one step further and break the numbers out (again) at the Congressional District level. I used a fairly simple methodology for this...I just took our CD-level projections from last summer and increased them by roughly the same percentage as the state as a whole. Note that all estimates are rounded off to the nearest thousand.

Neither Gee/Rapfogel nor I have into how much additional funding would be lost this time around at either the state or CD level...but I'm guessing it would be at least another $20 billion or so nationally on top of the $135 billion in lost federal funding which was already projected by the Urban Institute over a year ago.

(click images for high-res version)