Impacts of the ACA and Implications for Its Repeal

Congress is now considering partial repeal of the Affordable Care Act (ACA) through budget reconciliation. Because only components of the law with federal budget implications can be changed through reconciliation, this approach would permit elimination of the Medicaid expansion, the federal financial assistance for Marketplace coverage (premium tax credits and cost-sharing reductions), and the individual and employer mandates. It would leave the insurance market reforms (including the nongroup market’s guaranteed issue, prohibition on preexisting condition exclusions, modified community rating, essential health benefit requirements, and actuarial value standards) in place. There is no consensus around a replacement plan to enact as the ACA is repealed. Here, we present Urban Institute analyses to project and evaluate the impact of the ACA and the implications of the repeal under consideration.