Republicans now have control of the White House and Congress, and have begun pursuing policies that will repeal the Affordable Care Act in full or in part.
An earlier blog outlines national-level changes that could result from an ACA repeal. The Urban Institute found that under an ACA repeal similar to one proposed in Congress last year, the number of uninsured people nationwide would increase by nearly 30 million in 2019. This loss of coverage would be due to the elimination of the individual mandate and premium tax credits, as well as disruption in the non-group insurance market.
The impact in Florida could be especially serious, given that the state has been a leader in implementing the ACA; more people enrolled in marketplace plans in Florida in 2016 than any other state. Thus far, 1.6 million Floridians are covered, and about 880,000 people signed up for coverage that will start on January 1, 2017.
Under an ACA repeal, many Florida residents will likely lose their health insurance coverage, without an adequate replacement. A state-by-state analysis from the Center on Budget and Policy Priorities estimates that, in Florida, as many as 2.2 million fewer people could have coverage in 2019. This would include 1.4 million Floridians who would lose their premium assistance and be left without any affordable coverage options, according to a recent Families USA estimate. Premium assistance averages about $300 in Florida, which covers 78% of the total monthly premium for comprehensive coverage.
At the same time, the state, local governments and providers will likely face higher costs. In 2019 Florida could lose $6.1 billion in federal marketplace spending and $1.5 billion in federal Medicaid funding. It is expected that, nationwide, the increase in the number of uninsured residents could increase uncompensated care costs by $1.1 trillion nationwide between 2019 and 2028.
In addition, a repeal could mean that the 7.8 million Floridians who have pre-existing conditions could be left without an affordable option for coverage. It could also mean that 5.6 million Floridians, including 1.4 million children, could be subject to their insurance company limiting the amount of money it will spend on their care in a year or over their lifetime.
Coverage for preventive services and drugs could also be scaled back. If provisions that guarantee coverage for free preventive screenings were repealed, 7.3 million Floridians who have private coverage, including 1.4 million children and 4 million seniors on Medicare, could lose access to essential services like immunizations, blood pressure screenings and cancer screenings. Seniors could also face limited access to medications because the Medicare “doughnut hole” would re-open, leaving a gap in prescription drug coverage. This would put a stop to the savings that have accrued since the ACA closed this gap – about $1.4 billion thus far.
A repeal without an adequate replacement plan would likely cause an immediate and severe impact in Florida and across the country. To avoid this, policymakers must ensure that any healthcare policy changes that they pursue protect access to care.