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The Many Risks of the ACA Repeal Lawsuit — a Rundown


The Trump Administration and 18 state attorneys general are supporting a lawsuit that seeks to strike down the Affordable Care Act (ACA). If the lawsuit were to succeed, more than 21 million people would lose health insurance, recent Urban Institute estimates show. (See interactive map showing the increase in uninsurance rates by race/ethnicity and age.) Millions more would lose protections against discrimination based on pre-existing conditions.

A Court Decision Striking Down the ACA Would Raise Uninsured Rates Nationwide

Increase in Uninsured by State if the ACA Is Overturned, 2022

Source: Urban Institute estimates.

Notes: ACA = Affordable Care Act. NS = not shown. Some estimates have been suppressed here because sample sizes in some states are too small to confidently produce reliable estimates. Estimates assume Medicaid coverage expansion waivers in place in seven states before the ACA are reinstated. It is likely that some of these waivers will not be reinstated, however, making the estimated increase in uninsurance conservative.


Oral arguments before the Supreme Court are scheduled for tomorrow (November 10). The following CBPP materials outline the damage that would result from striking down the ACA.

Suit Challenging ACA Legally Suspect But Threatens Loss of Coverage for Tens of Millions
The ACA remains the law of the land for now, and legal experts across the political spectrum view the case against it as extremely weak. But if the courts “terminate” the ACA, as President Trump has urged, some 21 million people would become uninsured. This brief provides an overview of the lawsuit and its potential consequences. . . .

ACA Repeal Lawsuit Threatens Medicaid Expansion Coverage for Millions
If the Trump Administration and a group of 18 states convince the Supreme Court to strike down the Affordable Care Act (ACA), its Medicaid expansion — which covers more than 12 million low-income adults across the country — would end along with the rest of the law. That would take health coverage away from millions, reduce access to care, increase premature deaths, and increase medical debt and uncompensated care costs, research shows. It would also exacerbate racial disparities in coverage and access to care, and it would harm children along with adults. . . .

Commentary: ACA Repeal Even More Dangerous During Pandemic and Economic Crisis
Despite the COVID-19 pandemic and resulting major recession, the Trump Administration and 18 state attorneys general, led by Texas, continue to petition the Supreme Court to strike down the entire ACA. . . . The stakes in this case, always extraordinarily high, are even higher now amidst a global pandemic and an economic crisis that has caused more people to lose health insurance and become eligible for help from the ACA. . . .

Commentary: ACA “Alternatives” Don’t Protect People With Pre-Existing Conditions
With the ACA again at risk through the suit to strike down the law that is before the Supreme Court, some of its detractors are backing proposals they say would restore popular protections for people with pre-existing conditions if the law is overturned. But maintaining affordable coverage for people with pre-existing conditions would then require a complete set of rules for insurers and standards for benefits — plus financial assistance to make plans affordable for sick and healthy people alike and avoid the risk of an insurance market “death spiral.” None of the supposed alternatives to the ACA offered by the Trump Administration or congressional Republicans have these features. . . .

Eliminating Federal Protections for People with Health Conditions Would Mean Return to Dysfunctional Pre-ACA Individual Market
The ACA has enabled millions of Americans with medical conditions to obtain affordable, adequate health coverage in all states’ individual insurance markets. It did this not just by barring insurers from denying coverage outright to people because of a health condition, but also by requiring insurers to charge people the same premium, regardless of their health status and to provide a comprehensive array of benefits and cost-sharing protections.

If successful, [overturning the ACA] would mean a return to the highly flawed individual insurance market before the ACA, when people with health conditions often found it impossible to get adequate, affordable health coverage. . . .

ACA Suit Threatens Disruption, Loss of Protections for Tens of Millions of Medicaid, Medicare Beneficiaries
Tens of millions of Medicaid and Medicare beneficiaries face direct harm from a lawsuit to overturn the ACA — which strengthened and updated both programs, transforming Medicaid’s eligibility rules and Medicare’s payment systems. . . .

ACA Repeal Lawsuit Would Cut Taxes for Top 0.1 Percent by an Average of $198,000, Weaken Medicare Trust Fund
At the same time that millions of Americans would lose coverage — and tens of millions would lose key protections and/or pay more for coverage or care — high-income people and certain large corporations would receive very large tax cuts. That’s because striking down the law would eliminate the revenue measures that helped finance the ACA’s coverage expansions. . . .