Guest column: ACA repeal Is great … if you’re a millionaire

The repeal of large pieces of the Affordable Care Act (ACA) proposed by Congress would mean trouble for most Louisianans.

Even if you are not one of the 544,000 low- and middle-income people in our state who would lose access to affordable health care, you are likely to be impacted by the squeeze the repeal will put on the state’s budget. Millionaires, however, would have cause to celebrate because the plan to eliminate pieces of the ACA would result in them receiving a hefty tax cut.

Two groups of Louisianans stand to lose access to affordable health care in Congress’ current proposal. First are the 170,000 middle-income Louisianans who receive subsidies to purchase private health insurance in the federal health care exchange. These individuals, who earn between $16,000 and $47,000 per year if they are single and between $33,000 and $97,000 with a family of four, receive an average of $362 per month in federal tax subsidies to help pay their insurance premiums. This totals nearly $742 million in federal subsidies coming to Louisiana.

The second group that would lose coverage is composed of the 374,000 Louisianans who recently became eligible to enroll in Medicaid under Gov. John Bel Edwards’ executive order to expand the program. The majority of these new Medicaid recipients are part of the “working poor” class, including those who work full-time minimum wage jobs but still fall below the federal poverty line. In total, nearly 20 percent of the state’s adult population stands to lose access to affordable health insurance.

If you don’t currently receive federal subsidies or participate in Medicaid, you will not be free from the negative impacts of the proposed ACA repeal. Louisiana could potentially lose $26.7 billion in federal funding over the next 10 years, including more than $2 billion that would be lost in the first year after the repeal is implemented. What’s more, if the number of uninsured citizens rises to pre-ACA levels, we can be sure that emergency room visits and other costly uncompensated use of health care services will rise and put increased pressure on the state’s budget.

State officials estimate that Medicaid expansion already has saved the state $184 million in health care spending, but the state still faces a more than $300 million shortfall in the current budget cycle. Although many, including our governor, are pushing for significant tax reform to eliminate the state’s structural budget deficit, the loss of federal funding from the ACA will create another major hole in the state budget, one that will need to be filled with new taxes or cuts to public services including education, hospitals, and transportation.

So who stands to gain from the repeal of the ACA? Estimates from the Urban-Brookings Tax Policy Center show that the households with income above $1 million per year would each receive a tax cut averaging $57,470 per year. That’s more than the total annual income of any family in the bottom two-fifths of the population. Those with incomes over $4.8 million, the top 0.1 percent, would each get an average tax cut of $260,630 annually. The cuts would be the result of eliminating two ACA-imposed Medicare taxes on the wealthiest households.

If you are not one of these millionaires, it’s time reach out to your elected officials in Congress and ask them to halt the repeal of the ACA until they have developed a suitable replacement: a replacement that will not result in nearly one in five adult Louisianans losing health insurance coverage, leave a gaping hole in our state’s budget, and benefit only the richest.