ACA Repeal: What it means for Montana

Today, we released a new comprehensive report on the importance of Medicaid for access to health services for Montana children. Roughly half (51%) of Medicaid enrollees in Montana are children, and any effort to cap and cut Medicaid will most certainly impact access to affordable health care for children in the state.

That said recent press indicates that U.S. Senate Majority Leader Mitch McConnell may pivot to again forcing a vote on a full repeal of the Affordable Care Act (ACA) without a replacement in place. So while we are excited about our new report, we suggest dusting off our report from earlier this year, about what it means for Montana to repeal ACA without a replacement. Analysis shows that roughly 142,000 more Montanans would be uninsured.

Assuming Senator McConnell uses a similar version as the bill that passed in 2015, here are the highlights of the ACA repeal’s impact on Americans’ access to health insurance:

Completely end Montana’s bipartisan Medicaid expansion as of January 1, 2020. Montana’s Medicaid expansion has provided health insurance to nearly 80,000 Montanans. There would be no phase out. There would be no statutory option for states to keep their expansions. And, as Senator Daines has called for in the past, there would be no “place to land” for the tens of thousands of working, low-income Montanans who have received affordable coverage though expansion.

Completely eliminate the ACA’s tax credits and cost sharing subsidies – with no replacement – as of January 1, 2020. As of January 31, 2017, 44,415 Montanans have accessed tax credits and cost sharing subsidies, making health insurance affordable. These folks would be left with no help starting in two years.

Immediately repeal the ACA’s high-income and corporate taxes, cutting taxes for millionaires by over $50,000 per year.

What does this mean for Americans’ access to coverage? Based on CBO’s analysis of the previously proposed repeal bill:

  • Coverage: 18 million people would lose coverage in 2018, 27 million would lose coverage by the early 2020s, and 32 million would lose coverage by 2026. These losses reflect both elimination of Medicaid expansion and the virtual collapse of the individual market, as outlined below.
  • Individual market premiums: Compared to current law, premiums would be 20-25 percent higher in the first year, 50 percent higher by the early 2020s, and would double by 2026.
  • Individual market stability: By the early 2020s, about half of the U.S. population would live in areas with no individual market insurers, rising to 75 percent by 2026. Essentially, the individual market would collapse throughout most of the country.

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