How Would Your District Fare? Memo Breaks Down Nationwide Impact of ACA Repeal

With Republicans set to unveil their Affordable Care Act (ACA) repeal and replacement legislation this week, supporters of the healthcare law are warning of the "true cost" of scrapping the ACA, or Obamacare: loss of coverage for tens of millions of people, across many demographics and in each of the United States' congressional districts.

This comes as the GOP continues to duck a public accounting of the human and financial costs of its proposal--and as analysts raise the alarm over its potential tax toll on middle-class workers.

A memo (pdf) prepared this month by Democratic staff on the House committees on Energy and Commerce and Oversight and Government Reform offers some context for the secrecy, showing that "repeal of the ACA would endanger coverage for newly insured Americans, millions of whom live in Republican congressional districts."

Indeed, the analysis--based on federal health insurance data--found:

1. All congressional districts and the District of Columbia have seen reductions in their uninsured rates since the ACA was implemented, with an average reduction of 5.4 percentage points;
2. On average, 396,200 individuals with employer-sponsored insurance in each congressional district are at risk of losing important consumer protections if the ACA is repealed, and could be subject to a new tax on employer-sponsored insurance that would amount to the largest middle-class tax hike in the last 50 years; and
3. On average, 360,200 individuals in each congressional district stand to lose access to free preventive care if the ACA is repealed.

What's more, the analysis shows how constituents in Republican congressional districts have benefited from the ACA, in some cases with greater-than-average drops in uninsured rates.

Still, the analysis reads, "Despite the fact that significant numbers of their own constituents are currently enjoying the law's many benefits, House Republicans continue to pursue their extreme, ideological agenda of repealing the ACA at any cost."

The Indivisible movement, whose members spent a good portion of last month's Resistance Recess organizing to save the ACA, urged its supporters to "save this document," with its district-by-district breakdown, as ammunition for the fight ahead.

Advocates for specific demographic groups are also voicing concern about how the GOP's plan to repeal the law would impact their communities.

For instance, Ann M. Starrs, president of the women's health research group Guttmacher Institute, wrote in an op-ed Monday: "Full or partial repeal of the Affordable Care Act in particular would leave millions of women entirely without health insurance, while tens of millions more would see their insurance's contraceptive coverage severely degraded."

She continued:

It's the details that really matter here. The proportion of women of reproductive age (15-44) who were uninsured has dropped by more than a third over the first two full years of ACA implementation, driven both by states' expansions of Medicaid eligibility and gains in affordable private insurance. As efforts by congressional Republicans to repeal or otherwise scale back the ACA continue, it is unclear to what extent these gains in insurance coverage will be preserved. But the ACA has not only helped millions finally afford health insurance, it has also enhanced the quality of coverage for many others, including those who obtain insurance through their employers.

Yet one of the ACA's most critical such advances for women, the contraceptive coverage guarantee, may soon be gutted. The guarantee requires most private insurance plans to cover 18 distinct contraceptive methods without out-of-pocket costs, such as copays or deductibles.

This helps ensure women can choose the contraceptive method that works best for them, including [Intrauterine Device (IUD)]s and implants that often have high upfront costs. Some 55 million U.S. women are currently covered by the ACA's birth control benefit and for them, the policy has led to a steep decline in out-of-pocket costs for IUDs, the pill, and other popular methods, saving women and families $1.4 billion in 2013 alone. But Tom Price, the new secretary of the Department of Health and Human Services, has been openly hostile to this policy and the Trump administration could revoke or undermine it at any time.

In a separate op-ed published Monday at Common Dreams, writer Jamison Hill explained how repealing the ACA would impact chronically ill people like him.

"If the Trump Administration repeals the ACA, even simple treatments--like saline infusions and in-home nurse and doctor visits--will cost egregious amounts of money," wrote Hill, who suffers from a severe form of chronic fatigue syndrome known as myalgic encephalomyelitis, or ME. "My savings account has been zeroed-out, and I receive less than $900 in monthly disability checks. For the past year, my medical expenses alone have been more than $6,000 a month."

"The plans that have been floated to replace the ACA do little for people with disabilities or low incomes," he added. "A replacement would likely offer a flat credit based on age, and it wouldn't cover the care I need. It would also dramatically weaken Medicaid, decimating services for people with disabilities and serious illnesses."

And the AARP and other elder advocates are reportedly "bombarding congressional offices with objections" to the GOP's proposal this week, saying "people in their 50s and 60s could see premiums rise by $2,000 to $3,000 a year or more: increases of 20 percent to 25 percent or higher," according to the New York Times.

Indivisible is holding an emergency call on defending the ACA on Tuesday, March 7 at 9:00pm Eastern. Register here.