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PPACA: What if It Really Happens?

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Researchers have tried to estimate how the Affordable Care Act would affect each state if the major health coverage provisions were already in effect.

Republicans are working through Congress, the courts and state governments to try to block implementation of the Affordable Care Act – the federal legislative package that includes the Patient Protection and Affordable Care Act (PPACA).

Even if the Obama administration succeeds at implementing the act as written, many major provisions will not take effect until 2014.

But researchers at the Urban Institute, Washington, have tried to illustrate how the act might work by estimating how the major coverage subsidy and distribution provisions might affect coverage in each state and the District of Columbia if all provisions included were in effect today.

The researchers concluded that the percentage of nonelderly residents without coverage would drop in all jurisdictions. In New England, for example, the uninsured rate would drop to 4.7%, from 8.9%, the researchers say.

The national uninsured rate would fall to 8.7%, from about 19%, the researchers predict.

The researchers acknowledge that there are weaknesses in their methods. They are only starting to incorporate states’ individual health insurance rules in their forecasting model.

If all Affordable Care Act rules were in effect today, many U.S. residents would continue to get their health coverage from employer-sponsored group health plans and government health programs. Some also would continue to get ordinary individual health insurance. But the researchers believe 5% to 15% of nonelderly individuals would get their health coverage from a new system of health insurance exchanges that is supposed to help individuals use tax credits to buy carefully screened, standardized health coverage packages from commercial insurers.

The Urban Institute researchers did not analyze the possible effects of PPACA implementation on traditional commercial health plan enrollment.

The researchers did try to estimate the percentage of health insurance exchange customers who would have household incomes over 400% of the federal poverty level and receive no health insurance purchase tax credits.

Throughout the country, the percentage of exchange users with incomes over the tax credit cut-off could be about 31%, the researchers estimate.

The percentage of exchange users with incomes above the tax credit cut-off could range from a low of 18% in Mississippi to a high of 44% in Connecticut and New Hampshire.

- Allison Bell


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