The Graham-Cassidy legislation to repeal the Affordable Care Act (ACA) would cause an immediate downturn in healthcare employment, amounting to more than 267,000 fewer jobs in the industry by 2026, according to a report from George Washington University’s Milken Institute School of Public Health and the Commonwealth Fund.

Estimated job losses were less severe than previous ACA repeal bills. The House-passed American Health Care Act was projected to eliminate 725,000 healthcare jobs while the Senate’s Better Care Reconciliation Act would have reduced healthcare employment by 919,000 jobs.

Under Graham-Cassidy, healthcare employment would drop immediately, according to the study, declining by 47,000 jobs in 2018. The

“In 2020, funding for the Medicaid expansion and subsidies for health insurance marketplaces ends and is replaced with the smaller block grants. As federal funding losses deepen over time, revenues paid to hospitals, clinics, and health providers would decline. This in turn would lead to more healthcare employment declines and losses in other sectors like construction, retail, and finance,” wrote Leighton Ku, PhD, director of the Center for Health Policy Research at the Milken Institute and his coauthors.

By 2026, states which hadn’t expanded Medicaid would actually see a slight gain in healthcare employment of 9,500 jobs. This is because of the bill reallocating funding from the Medicaid expansion states to nonexpansion states. Texas, for example, would gain an estimated 13,833 jobs by 2026, while California would lose 43,490.

A separate report from S&P Global Ratings estimated high job losses in the overall economy under Graham-Cassidy, with employment declining by 580,000 jobs, compared to the Commonwealth Fund’ estimate of 345,000 jobs lost in the U.S. The S&P report didn’t quantify the healthcare sector’s losses, but said providers will be hit hard by the reduced funding under the bill’s proposed block grants.

“While most industries were shedding workers during the Great Recession, healthcare saw steady gains—and the sector continues to grow by leaps and bounds as aging Baby Boomers add to demand,” the S&P report said. “But one can't ignore the effects that hundreds of billions of dollars from Uncle Sam have had on the sector. In short, if the federal government turns off the faucet, it's not hard to imagine that business will dry up for a number of healthcare providers. And with less business, there would be less need to hire more workers--or even keep the ones they've got.”

The Graham-Cassidy legislation has been tabled for now by Senate Republicans, with cosponsor Sen. Lindsey Graham, R-South Carolina, promising, "We're coming back to this."