The Affordable Care Act, or Obamacare, is no longer new. But the radioactive aura of the law is still nowhere near its half-life. The health-care reform, initially signed into law in 2010, has become one of the hottest political issues of the era. Many Republicans are disgusted with the law, which includes an individual mandate requiring everyone to have insurance. Democrats, on the other hand, see it as a grand compromise. It’s a stepping stone, some think, on the way to a single-payer system.
Despite how you feel about it, it’s the law of the land. And it has withstood multiple lawsuits and trips to the Supreme Court. It was also an important factor in our national elections in 2010, 2012, and 2016. President Donald Trump, whose election is being cast as a rebuke to the Obama years, has promised to make a fast repeal one of the top items on his agenda.
But Republicans have run into some trouble. If they repeal the law, as many as 30 million people could lose insurance coverage. But if they don’t, they’re breaking a major campaign promise. It’s quite the political pickle.
Some states (and therefore Americans) stand to lose more than others if the law is repealed. To figure out which ones, WalletHub dug into the numbers. Citing a Congressional Budget Office report, WalletHub’s report says the ranks of the uninsured could rocket to as many as 32 million by 2026. And again, some states would feel the pinch more than others.
“In order to assess repeal’s impact on Americans based on where they live, WalletHub’s analysts compared the 50 states and the District of Columbia across seven key indicators of both economic and coverage losses,” the report says. “Our data set ranges from ‘growth in uninsured population by 2019 post-ACA repeal’ to ‘potential economic impact due to repeal of premium tax credits and Medicaid expansion (2019 to 2023).'”
In terms of which states would be the most affected by a repeal of the Affordable Care Act, here are the top 10.
An Affordable Care Act repeal would be particularly disastrous for the state of Connecticut, which could leave about a quarter of a million residents without health insurance. Particularly damaging for Connecticut residents would be the contraction of Medicare. Connecticut was the first state to expand Medicare under the Affordable Care Act, and the state would lose more than $10 billion in federal funding over the next 10 years if the law is repealed.
Ohio was one of a handful of Midwestern states that swung the election for Trump. Tapping into the blue-collar economic woes of the Rust Belt, Trump would actually be doing his supporters a disservice by repealing the Affordable Care Act. The state stands to lose billions in federal subsidies, and even Republican Gov. John Kasich is issuing stern warnings about the fallout of a full repeal.
Bordering Ohio to the north, Michigan was another state that helped swing the election to Trump. And like their neighbors, Michigan residents would deal with a lot of negative consequences related to the Affordable Care Act’s repeal. In rural areas especially, repealing the law could affect people’s lives in a number of ways. More than 630,000 people have enrolled in the state exchange, which would change if Republicans gut the law.
7. New Hampshire
New Hampshire narrowly tipped to Hillary Clinton during the 2016 election. But the state’s unique position in our election system gave us a glimpse as to the nationwide support Trump would eventually win. And just like in many other states that leaned Trump, New Hampshire would be among the states most heavily impacted by the Affordable Care Act’s repeal. Residents are nervous, and a lot of people could be left without coverage in the case of a repeal.
6. North Dakota
Yet another state that voted for Trump by a wide margin, North Dakota would feel the pinch if the Affordable Care Act is scrapped. As Republicans have postured to repeal the law, many North Dakota residents have started to sign up for plans in anticipation. Representatives from the state have been supportive of a repeal. We’ll have to wait to see what Republicans actually do to see the full effect.
Oregon is a blue state, and its residents generally support the law. If Republicans trigger a repeal, Oregon’s economy stands to take a hit — and its residents would lose coverage. After the Affordable Care Act became law, Oregon’s uninsured rate dropped by half. If the law were repealed, that progress would be scrapped, as well.
4. Rhode Island
Officials in Rhode Island are already positioning themselves for a potential repeal. The Affordable Care Act managed to lift 100,000 Rhode Island residents to the ranks of the insured after its passage — 30,000 through the state exchange and 70,000 through the Medicare expansion. A repeal would clearly create chaos.
“The state’s uninsured rate dropped to less than 4.5 percent, compared with nearly 12 percent in 2013, before the law went into effect,” said a report from Providence Journal.
Kentucky might be the most interesting (and confounding) state when it comes to a repeal. For one, many of the state’s residents evidently don’t understand their state exchange, Kynect, is, effectively, Obamacare. As Vox’s Sarah Kliff reported, some parts of the state benefited more from the Affordable Care Act than anywhere else in the country. And yet they voted for Trump, who promised to repeal the law.
2. West Virginia
West Virginia is largely in the same camp as Kentucky. It’s a state that has a lot to lose in the event of an Affordable Care Act repeal. But the state overwhelmingly supported Trump for president. The state would lose billions in subsidies, and people would lose coverage.
“The Affordable Care Act has had a wonderful impact on the state of West Virginia. It’s reduced the number of uninsured from 14 percent to 6 percent,” said Ted Boettner of the West Virginia Center on Budget & Policy, per a report from WOWK.
When it comes to a repeal, Massachusetts would be the biggest loser. Interestingly enough, Massachusetts’ former governor, Republican Mitt Romney, sowed the seeds of the Affordable Care Act by implementing Romneycare several years back. Now, if the nationwide law is repealed, more than 230,000 Massachusetts residents would lose coverage.