ACA Impact: A Tale of Three States

As the effort to repeal and replace the ACA steamrolls ahead, the peer-reviewed journal Health Affairs published a study outlining some of the positive impacts of the ACA over the last three years, focusing on how lower-income individuals fared in Texas, Arkansas and Kentucky, states that responded differently to the ACA.

Kentucky and Arkansas both used federal Medicaid funds to extend coverage (in different ways) to more lower-income people, while Texas did not. The study discusses the drop in uninsured and measurable improvements in both healthcare utilization and actual health indicators in the two states that expanded coverage, using Texas as a control.

Beyond helping to inform a point of view on the current debate, the article surfaces some issues employers will have to face if and when the ACA is repealed:

  • Given that the ACA was successful in bringing many uninsured into plans, what will be the impact in terms of cost-shifting to employers, plan members or carriers as these individuals become uninsured again?
  • How will the individual insurance markets react? Will they decline, similar to the public exchange markets?
  • What effects will we see in the potential workforce pool? Will new or prospective employees who have been uninsured be in poorer health as a result?

It’s worth having a conversation with your carrier or other health vendors now to see what their thinking is and how they are preparing. If the number of uninsured goes back to traditional levels, how will this affect the health systems your carrier contracts with – and, by extension, your carrier? What is their expectation for the impact on trend based on the repeal of ACA? The answer may differ based on the state in which you do business.   

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Eric Bassett
by Eric Bassett

Senior Partner, Association and Affinity Leader, Mercer

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