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ACA Repeal Resource Page

As the debate over the repeal of the Affordable Care Act evolves, CHCF is maintaining this list of data resources and analyses of the potential impact on California.

As the debate over the repeal of the Affordable Care Act (ACA) evolves, CHCF will maintain a list of data resources and emerging analyses, from CHCF and other organizations, on the potential impact on California. Resources are organized reverse-chronologically and cover the following topics:

This page will be updated regularly. If you have suggested additions, please email Anne Sunderland.

High-Risk Pools

House Health Care Plan Is Not Enough to Keep High-Risk Pools Afloat
Analyzes the April 26 version of the AHCA and finds that the bill's funding for high-risk pools would result in a shortfall of $2.5 billion in California — and almost $20 billion nationwide. A follow-up analysis, The Upton Amendment to the ACA Repeal Bill Will Have Almost No Effect (released May 3), includes the additional $8 billion added to the AHCA to further support high-risk pools over five years. It finds that the California shortfall remained $2.3 billion — and approximately $18 billion nationwide. (Center for American Progress, April/May 2017)

The False Equivalency of High-Risk Pools to Replace the ACA
Analyzes California's high-risk pool before the ACA, the Major Risk Medical Insurance Program, and finds that it was plagued by long waiting lists, exorbitant premiums, low annual and lifetime benefit caps, coverage exclusions for pre-existing conditions, and limited participation by health insurers. (Insure the Uninsured Project, April 2017)

High-Risk Pools for People with Preexisting Conditions: A Refresher Course
A national analysis of state-based high-risk pools before the ACA and the challenges they encountered. (Commonwealth Fund, March 2017)

Impact of Potential Elimination of the ACA's Cost-Sharing Reductions

The Effects of Ending the Affordable Care Act's Cost-Sharing Reduction Payments
Finds that ceasing payments for the ACA's cost-sharing reductions could save $10 billion but cost an additional $12.3 billion in premium tax credits — an estimated net increase of $2.3 billion, or 23%, in federal spending on marketplace subsidies — in 2018, if insurers continue to participate in ACA marketplaces. (Kaiser Family Foundation, April 2017)

Potential Impact to the Federal Budget of Not Directly Funding Cost-Sharing Reduction Subsidies (PDF)
Finds that if the Trump administration doesn't continue to fund the ACA cost-sharing reductions (CSRs), it will cost the federal government $47 billion over the next decade. Analysis projects that as a result of defunding CSRs, health plans would implement rate increases to pay for the CSR subsidies, which would increase federal spending for Advanced Premium Tax Credits far more than the cost of funding CSRs directly. (Covered California, April 2017)

Evaluating the Potential Consequences of Terminating Direct Federal Cost-Sharing Reduction (CSR) Funding (PDF)
Models the effects of an increase in premiums for Covered California silver plans that would result if the federal CSR subsidy were defunded and health plans had the opportunity to build the costs of such subsidies into their rates. A more detailed appendix (PDF) modeled the market impact of loading the CSR premium adjustment onto all plans, not just silver plans. (Covered California, January 2017)

Analysis of the American Health Care Act

In March 2017, House Republicans introduced the American Health Care Act (AHCA) to repeal and replace major components of the ACA. On March 24, Republican leaders decided to not bring the AHCA to a vote in the House of Representatives. An amended version of the bill was approved in the House on May 4.

The Impact of the American Health Care Act on Employment
Computes changes in federal spending and revenue from 2018 to 2026 for each state and projects the effects on states' employment and economies. Finds that the AHCA would raise employment and economic activity at first, but lower them in the long run. States that expanded Medicaid would experience faster and deeper economic losses. Projects that California would lose over 32,000 jobs by 2026. Read the California results (PDF). (Commonwealth Fund, June 2017)

Consequences for States of AHCA
Projects the effects of the proposed law on states' employment and economies. States that expanded Medicaid would suffer the most. (Commonwealth Fund, June 2017)

How Might Premium Costs Differ Within States Under the ACA and AHCA?
Compares 2020 consumer spending based on predicted differences between the tax credit structures of the ACA and the AHCA. Explore the map, brief, and state fact sheets. (National Academy for State Health Policy, June 2017)

Factors Affecting States' Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk? (PDF)
Examines 30 factors that could be high risk factors affecting states' ability to respond to proposed federal Medicaid cuts and financial restructuring under the American Health Care Act and proposed presidential budget. All states would face challenges adapting to federal Medicaid cuts and caps but states with specific characteristics would be at higher risk. (Kaiser Family Foundation, June 2017)

How Repealing and Replacing the ACA Could Reduce Access to Mental Health and Substance Use Disorder Treatment and Parity Protections (PDF)
Explains how the ACA expanded coverage for mental health (MH) and substance use disorders (SUD), and finds that repealing and replacing the ACA could reverse the decades-long effort to reduce historical disparities in MH and SUD treatment. (Robert Wood Johnson Foundation and Urban Institute, June 2017)

Republican Plans to End Medicaid as We Know It Would Threaten Medi-Cal Coverage and Benefits for Millions of Californians
Offers updated and in-depth data on Medi-Cal coverage in every California county, and describes how the AHCA could affect this coverage. (California Budget and Policy Center, June 2017)

The ACA and Medi-Cal: What's at Stake? (PDF)
Provides a detailed analysis of the changes to Medi-Cal under the ACA, and the potential impact the AHCA would have on the program. (Insure the Uninsured Project, May 2017)

Gaps in Coverage Among People with Pre-Existing Conditions
Estimates that 6.3 million people — 23% of the 27.4 million nonelderly adults with a gap of several months in insurance coverage in 2015 — could potentially face higher premiums under the House's AHCA, due to pre-existing health conditions. (Kaiser Family Foundation, May 2017)

Medicaid Cuts in House ACA Repeal Bill Would Limit Availability of Home- and Community-Based Services (PDF)
Discusses the potential impact of the AHCA on Medicaid-funded home- and community-based services (HCBS). Includes state-specific figures on number of Medicaid enrollees using HCBS and spending on seniors and children and adults with disabilities. (Center for Budget and Policy Priorities, May 2017)

House Health Care Bill Ends Medicaid as We Know It (PDF)
Discusses AHCA's Medicaid provisions. (Center for Budget and Policy Priorities, May 2017)

Summary of The American Health Care Act (PDF)
This fact sheet outlines the major components of the AHCA as passed by the House of Representatives on May 4, 2017, including a summary of all final amendments. (Insure the Uninsured Project, May 2017)

Compare Proposals to Replace the Affordable Care Act
Compares the AHCA, including amendments, to current law. (Kaiser Family Foundation, May 2017)

House GOP Health Plan Cuts Tax Credits, Raises Costs by Thousands of Dollars for Californians
Finds that in more than half of California's counties, cost increases for Covered California enrollees would average more than $4,000. Includes a California county-by-county analysis. (Center on Budget and Policy Priorities, April 2017)

House Narrowly Passes ACA Repeal-and-Replace Bill That Would Leave Millions Uninsured
Analyzes how the MacArthur amendment, introduced on April 26, would alter the potential impact of the AHCA. (Commonwealth Fund, April 2017)

The American Health Care Act: What Will It Cost Californians?
This joint information hearing of the California Assembly Committee on Health and Assembly Budget Subcommittee No. 1 was held on March 22, 2017, in Fresno. Below are the materials presented at the meeting:

Covered California Releases Regional Analysis of Support Provided to Consumers Under the Affordable Care Act Compared to Changes Proposed in the American Health Care Act
Compares the financial help that Covered California consumers would receive in 2020 based on the current ACA subsidies to the proposed subsidies of the AHCA. Provides side-by-side comparisons (PDF) for consumers age 27, 40, and 62 who earn $17,000, $30,000, or $75,000 per year in each of California's 19 rating regions. (Covered California, March 2017)

The Impact of the House ACA Repeal Bill on Enrollees' Costs
Analyzes the "net financial impact" (changes in premiums after the application of tax credits, plus cost-sharing) of the American Health Care Act on enrollees in the individual market by 2020 and 2026. National analysis with California-specific figures. According to the analysis, net costs would go up by $9,203 for low-income California families by 2020 and by $13,801 by 2026. (Center for American Progress, March 2017)

Coverage Losses by Congressional District Under the House ACA Repeal Bill
Calculates, for each congressional district in the country, the number of people who would be uninsured under the American Health Care Act for several categories of coverage types. National analysis with California-specific figures. Explore the data in this interactive map. (Center for American Progress, March 2017)

Tax Credits Under the Affordable Care Act vs. the American Health Care Act: An Interactive Map
Estimates, by county, premium tax credits consumers would receive under the ACA in 2020 with what they'd receive under the American Health Care Act as unveiled March 6 by Republican leaders in Congress. National analysis with California-specific estimates. (Kaiser Family Foundation, March 2017)

Preliminary Analysis of Impacts to Consumers from Changes in Premium Subsidies and Cost-Sharing Reductions Available Under the Proposed American Health Care Act (PDF)
Shows the financial assistance provided under the ACA to a variety of hypothetical Covered California enrollees (individuals or a family) in Los Angeles and San Francisco, with various ages and incomes compared to the financial assistance that would be provided under the AHCA. Estimates are based on 2017 premiums and costs. (Covered California, March 2017)

Gains in Health Care Coverage Under the ACA — and Potential Impact of Repeal

Impacts of the ACA on Insurance Coverage by Congressional District, 2013-2015
Provides data about changes in the uninsured between 2013 and 2015 by every congressional district in the country across a range of demographic characteristics (race, age, income, citizenship, etc.). Includes data tables and an infographic for each district. See California districts. (State Health Access Data Assistance Center, June 2017)

Medicaid Coverage of Effective Treatment for Opioid Use Disorder (PDF)
Finds drastically larger utilization of buprenorphine in states that expanded Medicaid under the ACA compared to those that did not. Per the report, increased utilization of buprenorphine treatment for opioid use disorder (OUD) under Medicaid could improve outcomes for expansion state residents for relapse, retention in OUD treatment, involvement in the justice system, health, and mortality. (Urban Institute, June 2017)

Medicaid in Small Towns and Rural America: A Lifeline for Children, Families, and Communities (PDF)
Examines the changing levels of Medicaid coverage and uninsured rates at the county level by age between 2008/2009 and 2014/2015, with a focus on rural areas and small towns. National analysis with California-specific data. For example, in California, the percentage of children in rural areas and small towns covered by Medi-Cal rose to 54% from 43% as the uninsured rate among that group fell from 10% to 4%. (Georgetown University Center for Children & Families and UNC NC Rural Health Research Program, June 2017)

California's Self-Employed and Small Business Employees Experienced Large Health Coverage Gains Under ACA
Finds that, before the ACA, nearly one in three self-employed Californians and those working for small businesses was uninsured. This dropped to one in five by 2015. More than 1.5 million self-employed Californians and those working for small businesses now have ACA coverage. (UC Berkeley Center for Labor Research and Education, May 2017)

Potential Impact of ACA Repeal on California: Premium Tax Credits
Interactive data map by SIS shows what it might cost Covered California consumers — by county, age, and income — if the ACA premium tax credits were eliminated. For example, in Alameda County premiums for some consumers could jump 467%, or nearly a quarter of annual earnings. (Social Interest Solutions, February 2017)

Fact Sheets: Medi-Cal Enrollment by District
Summarizes Medi-Cal enrollment data for August 2016 by US congressional district, California senate district, and California assembly district. (UC Berkeley Center for Labor Research and Education, February 2017)

Five Million Californians Could Lose Coverage Under ACA Repeal: Data by Congressional District (PDF)
The number of Californians covered under the Medi-Cal expansion and receiving financial assistance to purchase a plan via Covered California, organized by California congressional district. (Health Access, January 2017)

ACA Repeal in California: Who Stands to Lose?
Includes demographic breakdowns of those covered under the Medi-Cal expansion as well as subsidy-eligible Covered California consumers. The appendix details, per county, the number of people (and percentage of the overall population) represented by both groups — along with each county's uninsured rate 2013-2015. (UC Berkeley Center for Labor Research and Education, December 2016)

How Would Repeal of the ACA Affect Californians' Health Coverage?
Includes interactive map that shows, per county, the percentage of residents that are covered by either the Medi-Cal expansion or Covered California. (Pauline Bartolone and Lydia Zuraw, California Healthline, December 2016)

Covered California Enrollment by Zip Code, March 2016
This interactive map shows how many Covered California enrollees live in a given geographic area. (California Health Care Foundation, December 2016)

Medi-Cal Reaches Millions of People Across California, but Faces an Uncertain Future
Details, per county, the number of people (and percentage of the overall population) enrolled in Medi-Cal (both expansion and non-expansion populations). (California Budget and Policy Center, December 2016)

Facts and Figures on the ACA in California: What We've Gained and What We Stand to Lose
Highlights the impact of the ACA in California with a focus on coverage gains. (California Health Care Foundation, November 2016)

Obamacare Has Increased Insurance Coverage Everywhere
Includes a table of American Community Survey data that shows the change in the uninsured rate, and the drop in number of uninsured people, between 2013 and 2015 in each congressional district in the country. The four congressional districts with the biggest improvements are all in California. (FiveThirtyEight, September 2016)

Impact of ACA Repeal on Economic Indicators and Health Care Spending

Which California Industries Would Be Most Affected by ACA Repeal and Cuts to Medi-Cal?
Identifies which industries in California have the highest proportion of workers enrolled in either the Medi-Cal expansion under the ACA or Covered California with subsidies. Discusses how ACA repeal could impact these workers and the firms that employ them. (UC Berkeley Center for Labor Research and Education, February 2017)

Impact of Medi-Cal Expansion on California's Public Health Care Systems
Fact sheets on the impact of Medi-Cal expansion on public health systems and hospitals estimate potential revenue losses if Medi-Cal expansion is repealed and describe improvements in care delivery that are at risk. Includes estimates of potential job and GDP losses as well as increases in the uninsured rate in the county where the system or hospital is located. (California Association of Public Hospitals and Health Systems, February 2017)

How Would Repealing the Affordable Care Act Affect Health Care and Jobs in Your State?
Estimates losses in coverage and jobs due to ACA repeal. National analysis with California-specific estimates. (Economic Policy Institute, January 2017)

Fact Sheets: What Do California Counties Stand to Lose Under ACA Repeal? (PDF)
Summarizes potential coverage and economic losses in selected California counties: Fresno, Kern, Kings, Los Angeles, Madera, Merced, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare. (UC Berkeley Center for Labor Research and Education, January 2017)

Repealing Federal Health Reform: Economic and Employment Consequences for States
Includes national and California-specific estimates of job losses as well as declines in state and local taxes, gross state product, and other economic indicators in the event of an ACA repeal with no replacement plan. Also see the CHCF infographic on the California-specific figures. (The Commonwealth Fund, January 2017)

The Impact on Health Care Providers of Partial ACA Repeal Through Reconciliation
Estimates the reduction in spending on health care services by insurers (public and private) and households and the increase in uncompensated care that the uninsured would seek as a result of partial repeal of the ACA. National analysis with California-specific estimates. (Urban Institute, January 2017)

Implications of Partial Repeal of the ACA Through Reconciliation
Compares future health care coverage and government health care spending under the ACA and under passage of a reconciliation bill similar to one vetoed in January 2016. National analysis with California-specific estimates. Also see the follow-up brief, Partial Repeal of the ACA Through Reconciliation: Coverage Implications for California Residents. (Urban Institute, December 2016)

California's Projected Economic Losses Under ACA Repeal
Estimates losses in employment, gross domestic product, and state and local tax revenue in California under a partial repeal of the ACA. Also estimates losses for select counties with more than 10% of their population enrolled in the Medi-Cal expansion: Fresno, Kern, Los Angeles, San Bernardino, San Joaquin, Stanislaus, and Tulare Counties. (UC Berkeley Center for Labor Research and Education, December 2016)

What Coverage and Financing Is at Risk Under a Repeal of the ACA Medicaid Expansion?
Examines the changes in coverage and financing that have occurred under the Medicaid expansion to provide insight into the potential scope of coverage and funding that may be at risk under a repeal. National analysis with California-specific estimates. (Kaiser Family Foundation, December 2016)

Insurance Market Regulation Before Health Reform

Challenges of Partial Reform — Lessons from State Efforts to Reform the Individual and Small Group Market Before the ACA
Highlights the experiences of four states that unsuccessfully attempted to reform their individual and small group markets before the ACA — and how their failures should inform the current debate on repealing the ACA. Read the CHCF blog post on the paper. (PricewaterhouseCoopers, February 2017)

ACA Repeal Resource: California's Individual Market Before Health Reform
Provides an overview of California's individual market before the ACA, links to resources to learn more, and identifies potential concerns if the ACA is repealed. (California Health Care Foundation, February 2017)

How Accessible and Affordable Were Individual Market Health Plans Before the Affordable Care Act? Depends on Where You Lived (PDF)
Summarizes the laws of 50 states and the District of Columbia regarding guaranteed issue, preexisting condition exclusions, and health status rating in the individual market before the ACA. (Georgetown University Health Policy Institute, January 2017)

Pre-Existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA
Reviews medical underwriting practices in the individual health insurance market prior to 2014, and estimates how many American adults could face difficulty obtaining private individual market insurance if the ACA were repealed or amended and such practices resumed. National analysis with California-specific estimates. (Kaiser Family Foundation, December 2016)

General Resources

ACA Watch
As the federal repeal-and-replace debate unfolds, ITUP's ACA Watch will periodically highlight emerging federal proposals, Congressional and administrative actions, and potential impacts for health care and health reform in California. (Insure the Uninsured Project, updated regularly)

ACA 411: Tracking Health Reform in California
CHCF's interactive tool is intended to be a "one-stop shop" for data on the impact of the ACA on coverage, access to health care, and affordability in California. Includes data from a variety of sources. (California Health Care Foundation, updated regularly)

Covered California Data and Research
Includes a range of data on Covered California enrollment, membership, products, and prices. (California Health Benefit Exchange, updated regularly)

Research and Analytic Studies Division
Official statistics and analytical studies related to Medi-Cal that inform policy and assist DHCS in achieving its mission and goals. (California Department of Health Care Services, updated regularly)

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