If the next president and Congress repeal Obamacare — as many Republican elected officials want to do — there could end up being more people without health insurance than before the law went into effect, a new study says.
A total of 24 million more people would lose health coverage by 2021 if the Affordable Care Act was repealed, according to the study issued Monday by the Robert Wood Johnson Foundation and the Urban Institute.
That tally would be added to the 29.6 million who would still be uninsured even if the ACA's various programs had remained in place, for a total of 53.5 million uninsured people.
As a result, the uninsured rate would nearly double, to 19.4 percent of the U.S. population by 2021, according to the study.
"Thus, the uninsurance rate would be higher in 2021 without the ACA than it was in 2013," the year before the Obamacare law began taking full effect, a report on the study said.
In 2013, there were 47.5 million people, representing 17.6 percent of the population, who lacked insurance.
Matt Buettgens, senior research associate at the Urban Institute, and a co-author of the report, said, "It would be an unprecedented disruption of coverage."
At the same time, however, federal spending on health care for the nonelderly would be reduced by $927 billion from 2017 to 2026, the report found.
But state spending would increase by $68.5 million during the same time frame as the reductions in Medicaid spending "would be more than offset by increases in uncompensated [medical] care," for people who lack health coverage.
The ACA implemented three broad programs that are credited with dramatically driving down the uninsured rate since 2013: expansion of Medicaid programs to more poor adults; online marketplaces that sell government-subsidized private health insurance; and allowing younger adults to remain on their parents' health plans.
At the same time, nearly all Americans are now required by law to have some form of health coverage or pay a tax penalty.
Of the 24 million projected to become uninsured in the event of a full repeal, the bulk, or 14.5 million, would lose coverage they currently have through Medicaid and the Children's Health Insurance Program.
Another 8.8 million who would have been enrolled in private individual health plans would be uninsured after a repeal, the study found. And about 1 million adults under age 26 who would otherwise be on their parents' health plans will be uninsured.
The study also broke down who those uninsured people would be. More than 80 percent of those losing coverage would be in working families, and about 66 percent would have a just a high school degree or less. About half of the people who would lose coverage would be white, and 40 percent would be young adults.
About 9.4 million people who would have gotten subsidies, or tax credits, to pay for their Obamacare plan premiums would no longer get that aid, the report said.
Buettgens noted that last year, people were very concerned about — and Republicans struggled to draft a proposal to deal with — the possibility that about 8 million or so people would lose health coverage if the Supreme Court ruled that the government could not issue subsidies to customers of the federal Obamacare exchange HealthCare.gov.
"That would be about a third of what we're talking about here," he said of that case, which ended up being decided in the government's favor. "And it would start to happen immediately."
Buettgens said the potential for dramatic reductions in coverage likely would give lawmakers pause even if they were offered a veto-free path toward repealing Obamacare. He cited the example of Kentucky Gov. Matt Bevin, who won election last year after promising to repeal Medicaid expansion in the state, only to backtrack on that once in office.
The study comes as presumptive Republican presidential nominee Donald Trump has called for an end to the ACA, as top GOP officials have also demanded. At the same time, Trump has proposed a replacement plan that he says will "broaden health-care access" and "make health care more affordable."
"On day one of the Trump administration, we will ask Congress to immediately deliver a full repeal of Obamacare," Trump's campaign says on the section of its website entitled Healthcare Reform to Make America Great Again.
Trump has suggested several steps to replace Obamacare, including lifting restrictions that inhibit sales of health insurance across states lines, allowing insurance premiums to be fully deductible on tax returns, expanding the use of health savings accounts to bolster savings for medical purposes, block granting Medicaid funds to states and allowing prescription drug importation.
But it is not clear to what extent Trump's proposals would make up for the loss of health insurance by millions of people if Obamacare were repealed.
Buettgens said Trump's replacement plan did not have enough details to analyze how many people would end up having health insurance if Obamacare were repealed.
"Without specific details" such as how much states would get in block Medicaid grants "it's impossible to know how they would impact things," he said.
The Trump campaign did not immediately return a request for comment on the RWJF/Urban Institute study.
Spokesmen for the campaign of presumptive Democratic presidential nominee Hillary Clinton also did not immediately respond to a request for comment on the study. Clinton's own website says she will "Defend the Affordable Care Act and build on it to slow the growth of out-of-pocket costs."
While repealing Obamacare has been an oft-repeated mantra of the GOP since the ACA became law under President Barack Obama, a Democrat, coming up with a viable replacement for it has proved difficult for the party.
That difficulty has grown as the numbers of people covered by Obamacare has increased, raising the risk of a dramatic political backlash for the Republican Party if a repeal-and-replace plan led to a significant reduction in the number of people insured.
According to the Obama administration, about 20 million people have gained coverage so far because of the ACA. And the nation's uninsurance rate is, for the first time ever, below 10 percent.