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POLICY INSIGHT
BEYOND THE NUMBERS

Urban Institute: Huge Coverage Losses in All States Under Senate GOP Bill

Update, July 10th: We've added an interactive map to this post.

The number of uninsured non-elderly people would rise dramatically in every state under the Senate GOP health care bill, new Urban Institute estimates show — more than doubling in 25 states and more than tripling in four states (see map and table). The new figures further illustrate the high stakes for states and their residents from repealing the Affordable Care Act (ACA).

Overall, 24.7 million fewer non-elderly people would have health coverage in 2022 under the Senate bill than under current law, Urban estimates. That’s largely in line with the Congressional Budget Office (CBO) estimates issued earlier this week, which expect the number of uninsured to rise by 20 million in 2022 and 22 million in 2026 under the bill.

Some states would fare especially badly. The number of uninsured Ohioans would jump by more than 1.1 million in 2022, a 184 percent increase relative to current law. In Arkansas, the number of uninsured would increase by 367,000 or 200 percent. And in West Virginia, the number of uninsured would increase by 218,000 or 309 percent.

The largest drop by source of health coverage would be in Medicaid: nearly 16 million (22.8 percent) fewer non-elderly people would be enrolled in Medicaid in 2022, Urban projects. That’s not surprising, as the Senate bill cuts federal Medicaid funding by $772 billion over ten years, according to CBO, by effectively ending the ACA’s Medicaid expansion and converting virtually the entire program to a per capita cap. Faced with such enormous cuts, states would have little choice but to roll back eligibility for large parts of their Medicaid programs.

The Urban analysts note that because they estimated the Senate bill’s effect in 2022, they left out the longer-term impact of the federal cuts under the per capita cap, which would grow each year. In particular, the Urban estimates don’t account for the Senate provision lowering the cap’s growth rate below the House’s inadequate level starting in 2025. As Urban concludes, this provision would necessitate even more Medicaid enrollment cuts over time, further raising the number of uninsured under the Senate bill.

 
TABLE #1
Senate GOP Bill Would Increase the Number of Uninsured by Nearly 25 Million in 2022  
  Increase in Number of Uninsured % Increase in Number of Uninsured  
United States 24,700,000 80%  
Alabama 164,000 30%  
Alaska 67,000 61%  
Arizona 395,000 48%  
Arkansas 367,000 200%  
California 4,291,000 139%  
Colorado 575,000 134%  
Connecticut 324,000 187%  
Delaware 58,000 81%  
District of Columbia 61,000 208%  
Florida 1,525,000 62%  
Georgia 400,000 21%  
Hawaii 56,000 56%  
Idaho 107,000 51%  
Illinois 1,076,000 105%  
Indiana 666,000 123%  
Iowa 232,000 134%  
Kansas 120,000 35%  
Kentucky 541,000 231%  
Louisiana 410,000 120%  
Maine 60,000 81%  
Maryland 528,000 129%  
Massachusetts 109,000 46%  
Michigan 1,014,000 196%  
Minnesota 417,000 106%  
Mississippi 100,000 25%  
Missouri 297,000 50%  
Montana 113,000 134%  
Nebraska 105,000 59%  
Nevada 328,000 78%  
New Hampshire 118,000 195%  
New Jersey 1,002,000 154%  
New Mexico 317,000 176%  
New York 1,290,000 99%  
North Carolina 553,000 42%  
North Dakota 70,000 138%  
Ohio 1,122,000 184%  
Oklahoma 157,000 26%  
Oregon 511,000 183%  
Pennsylvania 1,221,000 197%  
Rhode Island 104,000 196%  
South Carolina 215,000 36%  
South Dakota 28,000 29%  
Tennessee 353,000 49%  
Texas 1,123,000 22%  
Utah 245,000 72%  
Vermont 39,000 170%  
Virginia 446,000 42%  
Washington 757,000 146%  
West Virginia 218,000 309%  
Wisconsin 286,000 73%  
Wyoming 23,000 33%  
Source: Linda Blumberg, et.al., “State by State Coverage and Government Spending Implications of the Better Care Reconciliation Act,” Urban Institute, June 2017.