More than 1 million healthcare jobs would be lost with ACA repeal

The healthcare industry would suffer the greatest job losses due to the loss of federal funds if parts of the Affordable Care Act (ACA) are repealed, according to an analysis from the Commonwealth Fund.

As the debate over what the current Congress will do to the ACA rages, the study offered three different scenarios: a repeal of the law’s Medicaid expansion, subsidies for buying health insurance or both.

If both provisions are eliminated, the study estimated 912,000 healthcare jobs would be lost in 2019, rising to more than 1 million by 2023. The industry would be losing $807 billion in federal funding over that time period, with job losses reverberating into other industries, like construction and finance.

“State and local governments could be faced with declining revenues, and safety-net health care providers would see their uncompensated care costs rise sharply as millions of people lose their insurance,” wrote Leighton Ku, PhD, MPH, director of George Washington University’s Center for Health Policy Research and his coauthors.

The job losses would be smaller if only one of the two programs is nixed by a repeal. If subsidies for health insurance premiums are eliminated, 369,000 healthcare jobs would be lost in 2019. If the Medicaid expansion is rolled back, it would cost 543,000 healthcare jobs nationwide, including 86,000 in the 19 states which didn’t expanded the program.

“For example, although Utah has not expanded Medicaid, federal repeal causes the state to lose nearly 9,000 jobs in 2019,” Ku and his coauthors explained. “Medicaid expansion in other states—like nearby Colorado, Arizona, Nevada, New Mexico, and California—spurs economic growth in those states. But because businesses and individuals there also buy goods and services from Utah firms, Utah’s economy benefits, too. Ending Medicaid expansion therefore creates losses for Utah and other nonexpanding states.”

The researchers outlined potential job losses in several expansion and nonexpansion states. In Pennsylvania, which did expand Medicaid, 57,000 healthcare jobs would be lost, with 40,300 attributable to loss of the expansion and 16,700 due to losing premium subsidies.  In Florida, the second-most populous state to opt out of the expansion, a total of 64,200 healthcare jobs would be lost, with 11,500 due to rolling back Medicaid eligibility nationwide.

While the study also dealt with job losses in other industries, it made clear the healthcare sector would be hit far harder than any other if and when the ACA is eliminated.

“The economic burdens for states and health care providers will be particularly detrimental,” Ku and his coauthors. “Because they serve so many uninsured and Medicaid patients, safety-net facilities such as hospitals and community health centers could be especially hard hit. Recent studies demonstrate that Medicaid expansions are associated with lower uncompensated care burdens for hospitals and with increased capacity at nonprofit community health centers, signaling the adverse consequences of reversing them. In the end, states could be forced to choose between cutting vital services and raising tax rates.”