December 2023

Not Only Would 20+ Million Lose Coverage, but the Entire Health Care System Would Be Thrown Into Chaos

Over the weekend, Governor Ron DeSantis (R-FL), Senator Lindsey Graham (R-SC), former Governor Nikki Haley (R-SC), and leading GOP Senate candidate Tim Sheehy (MT) echoed Donald Trump’s latest calls to “terminate” the Affordable Care Act (ACA). The MAGA GOP refuse to give up their war on health care, despite the ACA being more popular than ever with a record number of signups.

The consequences of ACA repeal would touch nearly every household in the country: in addition to 20 million losing coverage, over 135 million Americans with pre-existing conditions would lose critical protections, 49 million seniors would have to pay more for prescription drugs, and insurance companies would not be required to cover preventative care, such as vaccinations, contraception, and cancer screenings, and once again impose annual and lifetime limits on benefits and charge women more.  

Thirteen years after it was signed into law, the ACA is now woven into the fabric of our lives. Millions of Americans depend on the ACA in order to stay healthy. At a time when more people are covered by the ACA than ever before, the consequences would be devastating, particularly for women, people of color, older adults, people who live in rural areas, people with disabilities, and the LGBTQI+ community.

If the Affordable Care Act is repealed:

• GONE: 2.3 million adult children will no longer be able to stay on their parents’ insurance. 
• GONE: Insurance companies will be able to charge women more than men.
• GONE: Ban on insurance companies having annual and lifetime caps on coverage.
• GONE: Requirements that insurance companies cover prescription drugs and maternity care.
• GONE: Protections for 135 million Americans with pre-existing conditions, including 54 million people with a pre-existing condition that would make them completely uninsurable.
• GONE: Medicaid expansion, which covers more than 22 million people. 
• GONE: Quality, affordable coverage that over 15.5 million people who buy insurance on their own.
• GONE: Premium tax credits that make premiums affordable for 80 percent of people who purchase health care on the marketplace.
• GONE: 49 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.
• GONE: Critical funding for rural hospitals. 
• GONE: 61.5 million Medicare beneficiaries will face higher costs and disruptions to their medical care. 

Republican Threats Could Lead To Nearly 40 Million People Losing Their Coverage

• 40 Million People Would Lose Coverage. If Republicans succeed in repealing the ACA, nearly 40 million people will lose coverage. In 2023, over 16 million people have signed up for ACA marketplace coverage, over 22 million people are enrolled in Medicaid expansion coverage available due to the ACA, and another 1 million people have coverage through the ACA’s Basic Health Program.
• The Uninsured Rate Would Increase By 69 Percent. Repealing the ACA would increase the number of uninsured Americans from 26.6 million to 61.6 million, according to 2020 data. Americans of all ages would be impacted by coverage losses:
• 1.7 million children would become uninsured, an increase of 48 percent.
• 4.9 million young adults aged 19 to 26 would become uninsured, an increase of 76 percent. 
• 8.8 million adults aged 27 to 49 would become uninsured, an increase of 60 percent.  
• 5.6 million million older adults aged 50 to 64 would become uninsured, an increase of 95 percent. 

Overturning The ACA Would Worsen Racial Disparities In Health

The uninsured rate for Black Americans would spike to 20 percent, 32 percent for American Indian/Alaska Natives, 17 percent for Asian/Pacific Islanders, and 33 percent for Hispanics — compared to 13 percent for white Americans. 

• 3.1 Million Black Americans Would Lose Coverage. The Urban Institute estimates that 3.1 million Black Americans would become uninsured if the ACA were overturned. According to the Center on Budget and Policy Priorities, the ACA helped lower the uninsured rate for nonelderly African Americans by more than one-third between 2013 and 2016 from 18.9 percent to 11.7 percent. 
• 5.4 Million Latinos Would Lose Coverage. The percentage of people gaining health insurance under the ACA was higher for Latinos than for any other racial or ethnic group in the country. According to a study from Families USA, 5.4 million Latinos would lose coverage if Republicans repeal the ACA.
• 1.3 Million Asian/Pacific Islanders Would Lose Coverage. 1.3 million Asian/Pacific islanders would become uninsured if the ACA were overturned, according to estimates from the Urban Institute. Research shows the ACA cut uninsurance rates among Asian Americans by more than half–from nearly 20 percent to just under 8 percent — eliminating coverage disparities with white Americans.
• 488,000 American Indians And Alaska Natives Would Lose Coverage. According to the Urban Institute, the uninsurance rate for American Indians and Alaska Natives would more than double in 10 states if the ACA is overturned. Nationwide, 488,000 would lose coverage. 

Republicans Want To Put Insurance Companies Back In Charge, Ending Protections For The 135 Million People With A Pre-Existing Condition

• According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. This includes:
  • 44 million people who have high blood pressure
  • 45 million people who have behavioral health disorders
  • 44 million people who have high cholesterol
  • 34 million people who have asthma and chronic lung disease
  • 34 million people who have osteoarthritis and other joint disorders
• More than 17 million children, 68 million women, and 32 million people aged 55-64 have a pre-existing condition.

Republicans Want To Give Insurance Companies The Power To Deny Or Drop Coverage Because Of A Pre-Existing Condition

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. Now insurance companies could have the license to do this again. 

• A 2010 congressional report found that the top four health insurance companies denied coverage to one in seven consumers on the individual market over a three-year period. 
• A 2009 congressional report found that some of the largest insurance companies had retroactively canceled coverage for 20,000 people over the previous five-year period.
• The Kaiser Family Foundation estimates that 54 million people, or 27% of adults aged 18 to 64, have a condition that would have been grounds for coverage denial in the pre-ACA marketplace. 

Coronavirus Could Be Considered A Pre-Existing Condition. Without the ACA, millions of Americans who have contracted the coronavirus would likely be deemed as having a pre-existing condition and be at the mercy of their insurance companies who could refuse to pay for needed care. 

Source: Kaiser Family Foundation, 2016; 2019

Republicans Want To Give Insurance Companies The Power To Charge You More, While Their Profits Soar

• Premium Surcharges Could Once Again Be In The Six Figures. Republican threats to repeal the ACA could mean insurance companies once again could charge people more because of a pre-existing condition. The 2017 House-passed repeal bill had a similar provision, and an analysis by the Center for American Progress found that insurers could charge up to $4,270 more for asthma, $17,060 more for pregnancy, $26,180 more for rheumatoid arthritis and $140,510 more for metastatic cancer.
• Women Could Be Charged More Than Men For The Same Coverage. Prior to the ACA, women were often charged higher premiums on the nongroup market than men were charged for the same coverage. 
• People Over The Age of 50 Would Face A $4,000 “Age Tax.” Without the ACA, insurance companies could charge people over 50 more than younger people. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the 2017 Republican repeal bill, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to AARP.
• 80 Percent of People With Marketplace Coverage Would Pay More. If the ACA is repealed, consumers would no longer have access to tax credits that help them pay their marketplace premiums, meaning 80 percent of people who have marketplace coverage would see price increases.
• Seniors Would Have To Pay More For Prescription Drugs. Republicans’ plan to repeal the ACA, would make 49 million seniors pay more for prescription drugs because the Medicare “donut” hole would be reopened. 
• 60 Million Medicare Beneficiaries Could Face Higher Costs. In addition to paying more for preventive care and prescription drugs, Medicare beneficiaries could face higher premiums without the cost-saving measures implemented under the ACA. If Republicans are successful, seniors will also face less coordinated care. 
• Insurance Companies Would Not Have To Provide The Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care, and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.

Republicans Want To Give Insurance Companies The Power To Limit The Care You Get, Even If You Have Insurance Through Your Employer

• Insurers Could Reinstate Lifetime And Annual Limits On 179 Million Privately Insured Americans. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage for those insured through their employer or on the individual market. In 2009, nearly 6 in 10 (59%) covered workers’ employer-sponsored health plans had a lifetime limit, according to the Kaiser Family Foundation. 
• Americans Could Once Again Have To Pay For Preventive Care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers.
• Employers Could Eliminate Out-Of-Pocket Caps, Forcing Employees To Pay More For Care. Under the ACA, health insurers and employer group plans must cap the amount enrollees pay for health care each year. If the law is overturned, these cost-sharing protections would be eliminated. The ACA also barred employer plans from imposing waiting periods for benefits that last longer than three months.

Republicans Want To End Medicaid Expansion

• More Than 21 Million People Enrolled Through Medicaid Expansion Would Lose Coverage. As of 2022, more than 21 million people were enrolled in Medicaid in over 40 states and territories.
• Access To Treatment Would Be In Jeopardy For 800,000 People With Opioid Use Disorder. Roughly four in 10, or 800,000 people with an opioid use disorder are enrolled in Medicaid. Many became eligible through Medicaid expansion.
• Key Support For Rural Hospitals Would Disappear. States that haven’t expanded Medicaid have poorer financial performance than states that have expanded Medicaid. If Medicaid provisions in the ACA were to be stripped, all rural hospitals would face this financial cliff.

Republicans Are Willing To Sacrifice Your Care For More Tax Cuts For The Wealthy

• The Richest Americans Would See Tax Cuts Averaging $200,000. Overturning the ACA would cut taxes for the top 0.1 percent of earners by an average of $198,000.
• Drug Companies Would Save Billions. If the ACA is struck down, pharmaceutical companies would pay $2.8 billion less in taxes each year.
• Repeal Would Weaken The Medicare Trust Fund. A significant portion of the tax cuts resulting from ACA repeal would come “at the direct expense of the Medicare Trust Fund,” according to the Center on Budget and Policy Priorities.

North Carolina’s long-awaited Medicaid expansion program takes effect today, extending affordable health care to an estimated 600,000 people. The news comes as Donald Trump renewed calls to repeal the Affordable Care Act (ACA) — including Medicaid expansion — and rip coverage and core protections away from millions of Americans. 

Prior to this year, North Carolina was just one of 11 states that still refused Medicaid expansion after years of Republican obstruction. Democratic Governor Roy Cooper has fought tirelessly for expansion, making it one of his central priorities since taking office in 2017. In addition to securing coverage for those who need it, this measure will strengthen the economy, boost support for rural hospitals and other safety net providers, and relieve hardships for families living in poverty. Medicaid expansion will especially help low-income workers, moms and children, people with disabilities, and Black, Brown, Indigenous, and rural residents.

FEATURED:

President Joe Biden: “Every American deserves high-quality affordable health care. Today, we are one step closer towards meeting that promise, as 600,000 North Carolinians can now access the affordable, quality coverage they need under Medicaid. Thanks to Governor Roy Cooper’s years of leadership, in partnership with bipartisan elected officials, North Carolina is the 40th state to expand Medicaid under the Affordable Care Act.” [White House, 12/01/23]

Governor Roy Cooper: “Friday will be a historic day for North Carolina, with thousands of people across our state gaining access to critical health care. Medicaid Expansion will boost our economy, help keep rural hospital doors open and make our state a healthier place for all.” [X, @NC_Governor, 11/30/23]

Protect Our Care: “Today, North Carolina is celebrating this hard-fought victory after years of Republican obstruction. @NC_Governor, Democratic lawmakers, and advocates worked tirelessly for North Carolina’s #MedicaidExpansion for years — and now North Carolinians will see stronger hospitals, a better economy, and healthier communities.” 

[X, @ProtectOurCare, 12/01/23]

HEADLINES:

AP: Hundreds of Thousands in North Carolina Will Be Added to Medicaid Rolls This Week. “Expansion should help reduce the percentage of North Carolina’s adults under age 65 who are considered uninsured. A 2022 report from the National Center for Health Statistics estimated North Carolina’s uninsured population at 17.6%, significantly above the national average of 12.6%. The state currently has 2.9 million enrollees covered by some form of traditional Medicaid.” [AP, 11/30/23]

WBTV: Medicaid to Expand Dec. 1 to Include Nearly 600K Additional NC Residents. “Medicaid in North Carolina is set to expand on Dec. 1 to include nearly 600,000 more residents who have been stuck in ‘the gap.’ The policy change expands the range of income and household size residents need to qualify for benefits. ‘It means life. It means that people who didn’t have coverage, who wanted to be able to go to the doctor, who wasn’t feeling well but, ‘I can’t afford it now…’ People, even if you had been denied before, sign up, because it’s opened up to so many more people,’ pleaded 68-year-old cancer survivor DonnaMarie Woodson.” [WBTV, 11/29/23]

ABC11: NC Medicaid Expansion Starts December 1st. How Does It Work? “Eight months ago, Gov. Roy Cooper hailed Medicaid expansion as historic for the state. ‘This law, when implemented, will be the working families bill of the decade,’ Cooper said at the bill signing in March. And starting this Friday, the governor’s ‘bill of the decade’ takes effect.” [ABC11, 11/30/23]

North Carolina Public Radio: Expansion Adds Hundreds of Thousands of North Carolinians to Medicaid. “The state’s Republican-controlled legislature had for years rejected expansion, part of the Affordable Care Act that passed during President Obama’s administration and derided by opponents as ‘Obamacare.’ This year, however, the Tar Heel state changed course.” [WUNC, 12/01/23]

WECT: Local Leaders Preparing as Medicaid Expansion Starts Dec. 1 in North Carolina. “NCDHSS Director Kody Kinsley recently stopped by WECT and laid out the impact this coverage will have. ‘They’re gonna be able to go to the pharmacy and have their prescriptions covered. They’re gonna have the peace of mind that if they end up in the emergency room that’s going to be covered. It’s a game-changing opportunity for North Carolina’s health,’ Kinsley said.” [WECT, 11/30/23]

WFDD: Medicaid Expansion in North Carolina Could Help Narrow Racial Disparities in Health Care. “An estimated 600,000 people are set to benefit from the launch of Medicaid expansion on Friday. Experts say it could also narrow disparities in health coverage and access to care in North Carolina. According to data from the Center on Budget Policy Priorities, Medicaid expansion reduces uninsured rates between white people and people of color. The nonpartisan research institute studies federal and state policies.” [WFDD, 11/30/23]

WITN: State Medicaid Expansion Launching Today. “Under the new law passed by the North Carolina Legislature earlier this year, more than 600,000 North Carolinians may be able to get health care insurance through Medicaid even if they didn’t qualify before. The Medicaid Expansion covers people 19 to 64 years old with incomes that were too high under previous Medicaid guidelines but too low for private insurance, according to The North Carolina Department of Human and Health Services.” [WITN, 12/01/23]

WRAL: After 14 Years, Billions to Flow as 600,000 Qualify for Medicaid Insurance in NC. “The plan, a legacy of 2010’s federal Affordable Care Act, will mean billions of dollars — annually — for state hospitals and doctors as more people are enrolled in the government insurance program. That means more people getting routine checkups and seeking earlier intervention for health issues. That, policy makers hope, will keep people out of the emergency room and cut costs for hospitals, particularly in rural areas — and make for a healthier, more productive population.” [WRAL, 11/30/23]

WWAY: Medicaid Expansion Takes Effect Tomorrow, December 1st. “Medicaid Expansion will officially take effect Dec 1. This will allow more North Carolina residents, ages 19 through 64, access to healthcare. … Medicaid Expansion is designed to allow more people more access to coverage for doctor visits, yearly check-ups, emergency care, and more.” [WWAY, 11/30/23]

North Carolina Is the 40th State to Expand Medicaid, Extending Affordable Health Care to 600,000 North Carolinians 

Washington, DC — Today, North Carolina is beginning to implement its Medicaid expansion program, extending affordable health care to an estimated 600,000 people. As North Carolinians are finally given this long overdue relief, Republican lawmakers in 10 states are blocking the lifesaving program. As a result, nearly 3.5 million people are uninsured and have no options for affordable coverage. 

Back in Washington, Donald Trump and his MAGA allies renewed calls to repeal the Affordable Care Act (ACA) — including Medicaid expansion — and rip coverage and core protections away from millions of Americans. In addition to securing coverage for those who need it, Medicaid expansion strengthens the economy, boosts support for rural hospitals and other safety net providers, and relieves hardships for families living in poverty. Medicaid expansion especially helps low-income workers, moms and children, people with disabilities, and Black, Brown, Indigenous, and rural residents. Medicaid expansion is widely supported, with voters in seven states, including six red states, opting to expand Medicaid. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement:

“North Carolina is celebrating this hard-fought victory after years of Republican obstruction. Governor Cooper, Democratic lawmakers, and advocates worked tirelessly for North Carolina’s Medicaid expansion for years, and now North Carolinians will see stronger hospitals, a better economy, and healthier communities. Yet there is more work to be done to ensure every state is providing this lifesaving access to health care. Republican lawmakers in the 10 holdout states could not be more out of step with the American people on this issue — Medicaid expansion is widely supported across the nation, even in some of the deepest red states. It’s time to stop playing politics and deliver relief to the 3.5 million Americans who desperately need care.” 

Background On The States That Refuse To Expand Medicaid

• Alabama: Over 204,000 people would gain coverage if Alabama expanded Medicaid. Even though over 66 percent of Alabamians support Medicaid expansion adoption, Republicans continue to vote against the American people and lower-cost health care.
• Florida: If the state were able to expand Medicaid around 1.4 million Floridians could have access to coverage. Since 2012, when then-Governor Rick Scott pledged to never pass Medicaid expansion, the state Republican party has refused to take up the question.
• Georgia: Full Medicaid expansion in Georgia would provide coverage for up to 678,000 people in 2023, but Governor Brian Kemp and Republicans in the state legislature continue to block it. 
• Kansas: Governor Laura Kelly ran her campaign on bringing Medicaid expansion to Kansas; however, at every turn and in every legislative session she has been blocked by Republican state legislators. In all, over 82,700 people have been actively denied the quality and affordable health care they would be eligible for under Medicaid expansion by Kansas Republicans.
• Mississippi: Over 75 percent of all rural hospital closures from 2010 to 2021 occurred in states that had not adopted Medicaid expansion. Along with around 217,000 people who would be eligible for coverage under Medicaid expansion in Mississippi, expansion adoption would also open up billions in federal funding which could help end the hospital crisis plaguing Mississippi and leading to hundreds of excess deaths in the state.
• South Carolina: From the Governor’s office to the state legislature, Republicans in South Carolina have staunchly refused to expand Medicaid to over 345,000 people. 
• Tennessee: The Republican opposition to Medicaid expansion has meant that over $20 billion in potential funding to the state has been forfeited since 2014. Around 226,200 people would be eligible for low-cost health coverage if expansion was adopted and over 15,000 new jobs would be added to the state. 
• Texas: Expanding Medicaid would bring access to coverage to over 1.4 million Texans, but Governor Greg Abbott and Republicans in the legislature continue to block it. 
• Wisconsin: Republican legislators have shot down any proposals to adopt Medicaid expansion in the state, making it one of only two Midwest states to have not yet adopted the program. About 90,000 people in Wisconsin would be eligible for coverage under Medicaid expansion.
• Wyoming: Despite a proposal adopting Medicaid expansion passing through committees this year, state Republican leaders refused to allow a reading of the proposal on the state House floor, effectively killing the bill. Year after year legislation is introduced which would expand coverage to more than 34,000 people, and every time Republicans block these measures.