UPDATE 1/17/16: This morning the Congressional Budget Office released their projections of how many people would likely lose healthcare coverage if the GOP proceeds with a partial repeal of the Affordable Care Act. My state- and county-level estimates assume a full repeal (including wiping out regulations like guaranteed issue, community rating and so forth), which I estimate would add up to around 24 million people without including "Young Adults on Parents' Plans", or around 25.3 million with them included.
The CBO's projection, however, like the Urban Institute's, assumes a partial repeal, which would remove Medicaid expansion, federal subsidies and the individual/employer mandate penalties...but would leave the rest in place. This would actually have a more devastating impact, as it would decimate the off-exchange (full-price) individual market as well. They project around 32 million people losing coverage by 2026 under this scenario...or roughly 8 million more individual market enrollees than the 8.9 million I'm estimating under the full repeal scenario.
Of course, the number of off-exchange indy plan enrollees varies widely from state to state and even county to county, but if you want to get an idea of how the state/county-level numbers would look under the CBO "partial repeal" projection, simply double the number of individual market enrollees to each state/county.
For instance, in Oakland County, Michigan, my estimate is ~35,000 highly-subsidized exchange enrollees and ~53,000 Medicaid expansion enrollees, or around 88,000 total. Under the CBO's projection, I'd add roughly 35,000 more off-exchange and unsubsidized on-exchange enrollees, for a total of ~123,000 people losing coverage.
Alternately, you could just increase the TOTAL number for each state by around 1/3 to get a rough idea of the maximum possible devastation.
I've pulled together all of my state/county-level breakout entries into a single location (scroll down for links to individual states). This way people can look up specific states to see what the potential impact of the ACA being repealed would be in terms of people losing their healthcare coverage. I even added this link to the main menu above.
Remember: I'm only including those who I expect could lose their coverage, not the impact to Medicare, pre-ACA Medicaid, Group Coverage and so on.
Some important caveats which apply to all county-by-county breakouts, and a few which only apply to specific states:
YOUNG ADULTS ON PARENTS' PLANS:
PRIVATE PLANS VIA THE ACA EXCHANGES:
For example: Let's suppose that in a given county, 10,000 people selected QHPs during open enrollment last year, of which 85% received subsidies, in a state where I expect about 5% growth this year.
My estimate would be: 10,000 x 1.05 x 0.85 x 0.90 x 0.90 = 7,229 people enrolled, effectuated & receiving subsidies high enough that they'd be seriously screwed if taken way.
Finally, there's no need to "break out" the District of Columbia numbers; I assume the whole District is basically considered a single county.
Copyright © 2017, Charles Gaba / ACASignups.net