As promised, President Donald Trump on Jan. 20 issued an executive order to undo the Affordable Care Act, or ACA, as his first order of business. Republican senators wasted no time advancing the president’s agenda, either, using a powerful process known as budget reconciliation on Jan. 12 to begin rolling back large sections of the health law. Passage of the resolution followed in the U.S. House of Representatives two days later.
But much of the public as well as members of Congress, including several Republicans, have expressed concern about both the lack of a replacement for the current program and a clear timeline for its implementation — in addition to the cost of repealing the ACA.
Since former president Barack Obama’s signature health-care legislation — more popularly known as “Obamacare” — was passed in 2010, more than 20 million individuals have gained insurance coverage, resulting in the lowest uninsured rate in history by early 2016. Reversal of the law is expected to raise the uninsured rate by an estimated 18 million in the first plan year following repeal, then 32 million by 2026, according to official estimates.
What is clear from the prospect of the ACA’s dissolution is that certain states stand to suffer more than others. In order to assess repeal’s impact on Americans based on where they live, WalletHub’s analysts compared the 50 states and the District of Columbia across seven key indicators of both economic and coverage losses. Our data set ranges from “growth in uninsured population by 2019 post-ACA repeal” to “potential economic impact due to repeal of premium tax credits and Medicaid expansion (2019 to 2023).” Read on for our findings, expert insight and a full description of our methodology.
|7||New Hampshire||62.44||33||New York||30.48|
|14||District of Columbia||50.99||40||North Carolina||23.62|
For additional insight, we turned to a panel of experts in health, health-care reform and health insurance. Click on the experts’ profiles below to read their bios and thoughts on the following key questions:
- What are the most popular parts of the ACA? Which components would be most politically difficult to repeal?
- Are Health Savings Accounts, or HSAs, an effective strategy for helping families finance health-care costs?
- Do you believe it is possible to drive down the cost of health care through more market-based reforms?
- How do you see the role of employers in providing coverage changing over the coming years?
Ask the Experts
In order to assess the impact of the ACA’s repeal at the state level, WalletHub’s analysts compared the 50 states and the District of Columbia across seven key metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the most negative outcome for the state.
We then calculated the overall score for each state and the District using its weighted average across all metrics and constructed our final ranking based on the resulting scores.
- Growth in Uninsured Population by 2019 Post-ACA Repeal: Double Weight (~23.53 Points)
Note: This metric compares the uninsured population in 2016 against the uninsured population in 2019, assuming the ACA is repealed.
- Growth in Uninsured Population in 2021 (ACA Effective vs. Repealed): Double Weight (~23.53 Points)
Note: This metric compares the uninsured population in 2021 if the ACA remains in effect against the uninsured population in 2021 if the ACA is repealed.
- Presence of Planned Parenthood Funding: Half Weight (~5.88 Points)
Note: This is a binary metric that considers whether the state funds or has defunded Planned Parenthood. Repealing the ACA would partly entail defunding Planned Parenthood across the board.
- Potential Jobs Lost Due to Repeal of Tax Credits & Medicaid Expansion in 2019: Full Weight (~11.76 Points)
- Potential Economic Impact Due to Repeal of Premium Tax Credits & Medicaid Expansion (2019 to 2023): Full Weight (~11.76 Points)
- Growth in Uncompensated Care Costs in 2021 (ACA Effective vs. Repealed): Full Weight (~11.76 Points)
Note: This metric compares the uncompensated care costs in 2021 if the ACA remains in effect against the uncompensated care costs in 2021 if the ACA is repealed. “Uncompensated Care” refers to “hospital care provided for which no payment was received from the patient or insurer,” as defined by the American Hospital Association.
- Share of Young Adults with Health-Insurance Coverage: Full Weight (~11.76 Points)
Note: Under the ACA, dependent adult children are eligible for health-insurance coverage through their parents’ policies until the age of 26. Repealing the ACA would eliminate such eligibility, resulting in a large number of young dependent adults lacking insurance coverage. Thus, the larger the current percentage of the population aged 18 to 26 with health insurance, the more the state stands to lose upon dissolution of the ACA. Please note, however, that this metric considers only the population aged 18 to 24 due to demographic data grouping by the U.S. Census Bureau, which includes the population aged 25 to 26 within the 25 to 34 age bracket.
Sources: Data used to create this ranking were collected from the U.S. Census Bureau, Center on Budget and Policy Priorities, The Urban Institute, The Commonwealth Fund, National Conference of State Legislature and Alliance Defending Freedom.