This policy brief from the Urban Institute estimates the impact of the Senate’s Better Care Reconciliation Act (BCRA) on health insurance coverage and state government budgets for each state.  The Urban Institute estimates that the number of uninsured Americans would increase to 24.7 million by the year 2022, which is higher than the estimate of 20 million by the year 2022 from the Congressional Budget Office. Nationally, 20.1 percent of Americans would be uninsured by 2022, compared to 11.1 percent if the Affordable Care Act (ACA) remained the law. Of those who would become uninsured under the BCRA, 56.6 percent would be White, 21.0 percent would be Hispanic, 12.1 percent would be Black, 6.3 percent would be Asian and Pacific Islander, and 4.0 percent would be Other Races.

Under the BCRA, the percentage of uninsured in California would increase from 9.0 percent under current law to 21.4 percent under the BCRA, in Nevada from 14.6 percent to 26.1 percent, in Alaska from 15.4 percent to 24.7 percent, in West Virginia from 5.0 percent to 20.3 percent, in Ohio from 6.5 percent to 18.4 percent, and in Pennsylvania from 6.0 percent to 17.8 percent.

Federal funding for Medicaid would be $102.2 billion lower in 2022 under the BCRA than under the ACA (a 26.4 percent decline), and federal funding for premium tax credits and cost-sharing reductions would fall by $38.2 billion that year (an 84.0 percent decline). Federal funding for these two programs to Alaska would drop by 41.7 percent, to Nevada 48.2 percent, and to Kentucky 58.5 percent.

The policy brief was funded by the Robert Wood Johnson Foundation.

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