THE TORCH: CONTENTSBy Gabrielle Lessard, senior policy attorney
July 6, 2017

Congressional efforts to “repeal and replace” the Affordable Care Act (ACA) would dramatically increase the number of uninsured people in the U.S., and that would be bad for everyone.

The Congressional Budget Office (CBO) estimates that implementation of the Senate’s proposed Better Care Reconciliation Act (BCRA) would increase the number of uninsured people to 49 million by 2026. The BCRA’s burdens would fall disproportionately on low-income consumers, children and seniors, with Medicaid spending cut by 26 percent by 2026 and by 35 percent by 2036.

Immigrants would be directly impacted if the BCRA became law because under the current Affordable Care Act lawfully present immigrants (with the exception of DACA recipients) are eligible to obtain health plans and income-based subsidies through the health care exchanges. The BCRA would strip eligibility from all but the subset of lawfully present immigrants deemed “qualified” under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.  Many immigrants with humanitarian statuses or circumstances, applicants for lawful permanent resident status with approved visa petitions, and others would lose eligibility under the bill.

A policy that increases the number of uninsured people is bad for everyone because the lack of access to health insurance produces adverse physical and economic consequences for individuals, families and communities.

Being uninsured has been correlated with poorer quality of health care, lower rates of preventive care, and greater probability of death. Many uninsured people avoid seeking medical care unless they are faced with an emergency, or delay care until their symptoms become intolerable. As a result, the uninsured are less likely to receive a diagnosis in the early stages of a disease and are more likely to suffer complications from aggravated medical conditions. They are at particular risk from diseases that are asymptomatic or produce only minor symptoms, such as high blood pressure and diabetes.

Health insurance also plays a major role in managing financial risk for individuals and families. Families with even one uninsured member face stigma, anxiety and the potential for financial catastrophe. Uninsured individuals who become hospitalized experience a host of financial setbacks over the next four years, including reduced access to credit, a 170 percent increase in unpaid medical bills, and a significantly higher likelihood of filing for bankruptcy.

The economic consequences of poor health extend beyond individuals and families.

People without insurance are often in poor health, which results in multiple dimensions of lost economic productivity: adults whose health status prevents them from working, workers who miss time from their jobs because of health problems, and workers who are working but less productive because of their health conditions or worries about a family member. Health-related productivity losses are estimated to reduce U.S. economic output by $260 billion a year.

Importantly, providing healthcare creates jobs and drives economic activity. A Commonwealth Fund analysis of the House “repeal and replace” bill, which is similar to BCRA, found that implementation of the bill would result in the loss of 924,000 jobs and a $148 billion decrease in business output by 2026.

The presence of a high concentration of uninsured individuals compromises access to health care for entire communities. Health systems prefer to invest in affluent areas that have higher rates of insurance. Physicians generally prefer working in newer, more up-to-date facilities over under-resourced health centers in low-income communities. Hospitals in areas with high rates of uninsured struggle with recruiting on-call specialists, resulting in longer wait times for emergency room visitors – regardless of their health insurance status. Lower rates of insurance within a community result in a decrease in availability of primary, preventive, specialty, and hospital-based care services, and may result in the closure or privatization of local community hospitals.

When many members of a community are uninsured, all members of the community are affected. Both the insured and the uninsured benefit physically and financially when every person in a community has access to affordable health coverage. It is in everyone’s interest to promote access to health care for all. Congressional health care proposals that would add millions to the number of uninsured are shortsighted and self-destructive.