The Affordable Care Act (ACA) was enacted in 2010 and implemented in 2014. Before and after its implementation, numerous efforts were made to repeal and replace the law. The ACA substantially affected the number of uninsured and the financial stability of the health care system. Presidential candidate Donald Trump's campaign has suggested revisiting efforts to repeal and replace the ACA, repeatedly claiming it to be a disaster.

Why This Matters

Studies conducted by the Congressional Budget Office and the Urban Institute on efforts to repeal the ACA, largely in 2016 and 2017, found substantial effects on the number of uninsured, government spending, provider revenues, and the need for uncompensated care. There are several reasons to believe these results would understate the effects if repeal were enacted today.

What We Found

Studies from the Congressional Budget Office and the Urban Institute provided largely consistent estimates of the effects of repeal on coverage and spending. Findings include the following:

• The number of uninsured would increase by 21–24 million with full repeal and 30–32 million with partial repeal; in the latter, Medicaid expansion and premium subsidies are eliminated, but insurance reforms are not.
• Federal spending would fall by about 1 trillion over 10 years under full repeal and somewhat more with partial repeal.
• State spending would fall because of the elimination of the Medicaid provisions in the ACA, but that would be more than offset by funding to help providers with increased uncompensated care burdens.
• Providers would see substantial reductions in revenues, about $1.7 trillion over 10 years for all services under partial repeal, including about $600 billion for hospitals.
• The demand for uncompensated care would increase, and whether and how this is paid for is unknown: through increased federal or state spending or by providers themselves.

How We Did It

We reviewed major publications by the Congressional Budget Office and the Urban Institute that analyzed the most important repeal legislation introduced in 2016 and 2017.