A repeal of the Affordable Care Act would reduce healthcare spending by more than $145 billion in 2019 and cause people to seek an additional $88 billion in uncompensated care, according to a recent study by the non-partisan Urban Institute.
Hospitals would be hit hardest. Their spending would drop by $59 billion in 2019 and they would likely shoulder $24.6 billion more in charity care.
John Holahan, a fellow at the institute who worked on the paper, believes ACA repeal would overwhelm providers.
“You can't say that providers won't figure out a way but it's just hard to see,” he said.
The study shows that physician practices would see a reduction of about $20 billion in spending and there would be $32 billion less spent on prescription drugs.
Uncompensated care sought from physician practices would be $11.9 billion and $18 billion would be asked for to pay for prescription drugs.
Billions more in charity care would be needed after ACA provisions were repealed and the individual insurance market would collapse, leaving up to 20 million without coverage. Federal and state governments could help cover some of those costs but it is also likely people would be forced to forgo care.
“Without additional government spending, the reconciliation bill would lead to bigger financial losses for providers and even larger increases in unmet healthcare needs among the uninsured,” according to the study.
In the first week of the Congress, Republicans are pushing repeal of the ACA through the process of budget reconciliation, which requires only a majority vote. Legislation has already been introduced to make good on a key promise of President elect Donald Trump and the Republican majorities.
The Urban Institute estimate uses the repeal bill Congress passed in January 2016, which Republicans knew President Barack Obama would immediately veto. Republicans have more recently suggested a delayed repeal and a transition period for those with ACA coverage. They have not provided many details, however.
The paper also estimates spending for 2019-2028 to be $1.7 trillion lower during the same period if there was no repeal and the uncompensated care figure for that time period to be $1.1 trillion.
Another recent study commissioned by the American Hospital Association and the Federation for American Hospitals found that hospitals would see a net negative impact of $165.8 billion from 2018-26 along with losses of nearly $290 billion in Medicare inflation updates and more than $100 million in disproportionate share payment reductions.
In a letter to Trump and congressional leaders, AHA CEO Rick Pollack and FAH CEO Chip Kahn said such losses must be avoided.
“Losses of this magnitude cannot be sustained and will adversely impact patients' access to care, decimate hospitals' and health systems' ability to provide services, weaken local economies that hospitals help sustain and grow, and result in massive job losses,” they said.