Killing the Affordable Care Act (ACA) Medicaid expansion program along with the ACA public exchange system could have a significantly bigger effect on the U.S. uninsured rate than simply killing the ACA public exchange system.

Related: CBO: Health Barriers Abound

Matt Buettgens and other analysts at the Washington-based Urban Institute, a nonprofit research center commonly viewed as being supportive of the ACA, have analyzed the possible effects of killing the big ACA health coverage expansion programs in a new paper.

The ACA exchange system gives consumers with incomes from 100 percent to 400 percent of the federal poverty level the ability to use federal tax credit money to pay for health coverage.

The ACA Medicaid expansion program provides federal cash states can use to get low-income childless adults enrolled in Medicaid.

Buettgens and his colleagues predict in the paper that eliminating the two programs would increase the number of uninsured people in the United States to 53.5 million in 2021, from about 30 million if the exchange and Medicaid expansion programs stay in place.

Federal Medicaid spending would drop to $286 billion, from $364 billion, but states would reduce their share of Medicaid spending by just $11 billion, to $208 billion, the analysts estimate.

For a look at some numbers showing how the analysts think saving Medicaid expansion, but killing the exchange system, might affect the U.S. health care system in 2021, read on:

Medicaid

If the Affordable Car Act’s Medicaid expansion program was eliminated, there would be 14.5 million more uninsured people. (Photo: iStock)

By the numbers

U.S. residents ages 65 and older already qualify for Medicare, a nearly universal health coverage program for the elderly.

The Urban Institute analysts estimate that the United States will be home to about 276 million people ages 64 and younger and 2021.

Killing the ACA Medicaid expansion program would increase the number of uninsured people in the country by 14.5 million, or 5.2 percentage points, according to the analysts’ data.

Killing the exchange program would increase the number of people with incomes under 400 percent of the federal poverty level who lose access to individual exchange plan coverage by 9.4 million. That could increase the uninsured rate by 3.4 percentage points.

Exchange plan users would make up about 40 percent of the people affected by the elimination of the two programs.

Eliminating both programs could cut federal health care spending by about $91 billion in 2021, the analysts say. The government might spend about $78 billion less on Medicaid and Children’s Health Insurance Program coverage, $39 billion less on exchange plan user subsidies, and about $27 billion more uncompensated care.

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