Implications for Households if the Supreme Court Overturns the Affordable Care Act

Researchers provide an overview of how overturning the ACA would affect average, hypothetical individuals using realistic information on premiums, subsidies, and ACA program eligibility. Moderate- and low-income families and those with health problems stand to lose the most.

The Issue

The U.S. Supreme Court is set to hold hearings on California v. Texas in November 2020, a case in which the plaintiffs argue the court should invalidate the Affordable Care Act (ACA) in its entirety.

Key Findings

If the ACA is overturned by the Supreme Court and its consumer protections are eliminated, increases in household costs would disproportionately impact families with moderate and low incomes due to the loss of premium tax credits, cost-sharing subsidies, and the Medicaid eligibility expansion, according to researchers.

• The average subsidized adult enrolling in a marketplace plan as an individual (5.8 million people in America) would lose $5,550 in assistance.

   

• Another 2.7 million people enroll in subsidized marketplace plans with their family members, and they would lose an average of $17,130 per family in premium assistance.

   

• The analysis also finds that more than 50 percent of those currently enrolled in individually purchased (i.e., nongroup) insurance have been diagnosed with at least one of a list of serious medical conditions. These people are particularly vulnerable to losing access to necessary medical care if the ACA is overturned.

   

Conclusion

The analysis, which comes approximately one month before the Supreme Court is expected to hear arguments on the constitutionality of the ACA in California v. Texas, explains how ending guarantees of affordable insurance coverage to people with medical conditions could raise their premiums to extremely high levels, exclude benefits for the care they need, or allow insurers to deny coverage altogether. Repealing the ACA would also reimpose annual coverage limits, greatly increasing people’s exposure to out-of-pocket expenses in the face of serious health care needs.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research. 

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