Into the Obamacare Repeal Charnel House

Our team of Lauren Fox and Tierney Sneed have been doing a superb job keeping us up to date on Republican plans to repeal Obamacare and phase out Medicare, often getting the key stories as much as a couple days in advance of the competition. (Sweet!) Today I want to show you some hard, granular numbers on the human toll of what Republicans plan to prepare for President Trump’s signature right out of the gate next month. Depending on how they go about it, we are talking about tens of millions of Americans who are about to lose their health insurance coverage. Some people might think that’s a big deal. For the moment the main policy debate within the GOP is how to accomplish this and evade as much blame as possible.

Let’s start with numbers put together by Charles Gaba. If you’re a health care or Obamacare nerd you know about Gaba’s site. He’s been meticulously collecting data on enrollments, coverage, exchanges, etc. since the ACA started going into effect five years ago. If you’re not familiar with it, here’s his site. Today he’s put out of chart detailing how many are set to lose coverage in the event of full Obamacare repeal.

Let’s start with some toplines. The total number set to lose their coverage is a bit over 23 million Americans (23,134,000). Of those, 12,311,000 lose their Medicaid expansion-based coverage; 8,963,000 are exchange purchasers who benefit from significant federal subsidies; 1,390,000 are young adults under the age of 26 who are allowed to remain on their parents plans; a final 470,000 are basic health care plan enrollees in Minnesota and New York.

Here’s Charles’ spreadsheet showing you how many Americans are on the chopping block in each state.

Just a few examples at random. Michigan: 981,000 lose coverage. Arizona: 576,000. Florida: 1.425 million. In other words, a lot of people.

And here’s something even more interesting, partial repeal turns out to be worse than full repeal. The Urban Institute has a new study showing something that seems paradoxical, but actually makes sense if you know the way the health insurance industry has integrated with and remade itself to operate with the ACA. Urban Institute’s numbers of people who lose insurance is slightly lower than Gaba’s numbers. They project 22.5 million as opposed to Gaba’s 23.124. But if repeal is partial, they project an additional 7.3 million would lose their coverage. That brings the total to 29.8 million, close to 10 percent of the people in the entire country.

Why would partial repeal hurt more people than full repeal? Well, in this case partial repeal means repealing the money (the incentives) without the regulatory structure. In the words of the Urban Institute study: “The additional 7.3 million people become uninsured because of the near collapse of the nongroup insurance market.” Basically you’re leaving the regulations intact but removing the money that makes them possible. So everything goes haywire and you get a lot of collateral damage. Why would you do that? Simple. The rules of the Senate allow you to do that with 50 votes. It’s politically easier to destroy care for an additional 7 million people.

One more thing to consider as these people are losing their health insurance. A bit part of the equation that very few people are talking about is that repealing the money part of the bill is a massive tax cut for the wealthy. That’s the part that Ryan wants to get his hands on first. That’s the real prize.

So take a look at the list. See how many people are about to lose their health insurance coverage in your state. Maybe you’re one of them.

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