Wednesday, 20 Nov 2019

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Who Is At Risk to Lose Insurance if the ACA is Changed or Repealed?

If Congress changes or repeals the Affordable Care Act (ACA), which adults are at risk of losing health insurance? A new research letter published online by JAMA Internal Medicine reports on their socioeconomic characteristics, rates of chronic disease and health care use compared with adults covered by employer-sponsored health care who are unlikely to be affected by changes in subsidies on the exchanges or to Medicaid.

A better understanding is needed of the health and health care use by individuals at risk of losing insurance because the 2016 election results suggest the ACA will be modified or repealed.

Pinar Karaca-Mandic, Ph.D., of the University of Minnesota, Minneapolis, and coauthors identified three groups of adults younger than 65 at risk to lose health insurance if premium tax credits are eliminated and Medicaid expansion is rolled back. The authors used part of the 2015 National Health Interview Survey.

The three groups of adults younger than 65 were: those with incomes below 400 percent of the federal poverty level (FPL) who bought insurance through the exchanges; childless adults with incomes below 138 percent FPL covered by Medicaid who do not receive disability income (newly eligible adults covered by Medicaid under the ACA); and Medicaid-enrolled parents or adults in families with children who did not receive disability income and whose income was 50 percent to 138 percent FPL (before the ACA, the median eligibility threshold was slightly higher for parents or adult caretakers).

The study reports that if Congress changes or repeals the ACA, the adults at risk to lose insurance are more likely to be minorities, poor and unemployed with less educational attainment than those with employer-sponsored insurance.

Also, the adults at risk to lose insurance had higher rates of self-reported poor health and in many cases were more likely to have certain chronic diseases, have visited the emergency department at least once, been hospitalized and have 10 or more physician visits in the past 12 months, according to the results.

The study did not include children who got coverage through exchanges and did not consider the impact of other possible ACA modifications, including changes to plan affordability, protections against preexisting conditions or changes to state Medicaid block grant programs.

“Our analysis highlights the socioeconomic vulnerability and rates of chronic diseases and health care utilization of individuals at risk to lose health insurance if the ACA is modified or repealed such that premium tax credits are eliminated and Medicaid expansion is rolled back,” the article concludes.

The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

So it seems that the groups most at risk of losing coverage are the same groups of individuals that didn't have coverage before ACA. It was quite clear that the real world effect was that far, far more Americans saw negative impacts from ACA than positives. In my personal experience I saw patiet premiums sky rocket while at the same time so,did deductibles, yet covered services and drug formularies suffered. There is absolutely no doubt that for working Americans the yearly out of pocket cost of health insurance escalated drastically, while at the same time, benefits declined. Granted, ACA helped some socially disadvantaged groups, but harming 90% of a population to help 10% is far from solution. So I welcome an escape from ACA, which, in my opinion, was simply a failed federal governmental social experiment inclusive of over reaching legislation and regulatory excess that was embraced by many from a "we must do SOMETHING" perspective and yet held little sway from a perspective of logic and reason. "It is the greatest happiness of the greatest number that is the measure of right and wrong", was the axiom of utilitarian philosopher Jeremy Bentham which serves well here.

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